Urinary tract infection following kidney transplantation: frequency, risk factors and graft function

Abstract

The aim of this study was to determine the proportion of children who develop urinary tract infection (UTI) after kidney transplantation (KTx) and to identify the factors associated with UTI and its impact on graft function. To this end, we undertook a chart review of children who underwent KTx at Red Cross Children's Hospital between January 2003 and December 2009 and were followed-up for at least 6 months after transplantation. Sixty-two children (53.2% males) were followed-up for a mean (standard deviation) period of 36.9 (19.7) months. Mean age at transplantation was 10.0 (4.6) years. Twenty-five (40.3%) children had 89 UTI episodes during the study period, equivalent to 0.94 UTI episodes per one patient-year of follow-up. Acute pyelonephritis occurred in 17 (27.4%) children; another 17 (27.4%) had multiple post-KTx UTI. Klebsiella (40.0%) and Escherichia (28.0%) were the commonest organisms. Those with post-KTx UTI were, at transplantation, younger (8.3 vs. 11.2 years; p = 0.017), had lower urinary tract abnormality (LUTA) (13 vs. 1; p = 0.000) and had pre-KTx UTI (13 vs. 5; p = 0.001). Multivariate analysis revealed that only age <5 years at transplantation and LUTA remained significant and that UTI KTx was not associated with worsening graft function. UTI is common after post-KTx. Among our patient cohort, younger age and LUTA were risk factors, but UTI did not affect graft function.

Does Lower Urinary Tract Status Affect Renal Transplantation Outcomes in Children?

“…Several studies concluded that the presence of lower urinary tract abnormality is a significant risk factor for posttransplant UTI [12,13]. However the prevalence of UTI in LUTD (þ) patients varies widely in the literature due to many factors, such as differences in the definition of UTI, agents chosen for prophylaxis, etc.…”

When does vesicoureteral reflux in pediatric kidney transplant patients need treatment?

“…Surprisingly, functional bladder disorders do not increase the risk for UTI or the incidence of UTI after transplant, but patients with recurrent UTI have a more rapid decrease in GFR . Obstructive uropathy, pretransplant pyelonephritis, pretransplant vesicoureteral reflux, age <5 years, and congenital anomalies of the kidneys and urinary tract (mainly posterior urethral valves) have been identified as risk factors for post‐transplant UTI . However, at 2‐year follow‐up, no difference could be shown in eGFR between patients with febrile UTI and those without febrile UTI.…”

Infections Following Kidney Transplant in Children: A Single-Center Study

“…Kidney transplantation (KT) is the treatment of choice for end-stage renal disease (ESRD) in children [1] [2]. Despite improvements on immunosuppressive therapy and surgical techniques, infections remain important complications and have been associated with increased morbidity and graft rejection [3] [4].…”