Logo Annals of Transplantation Logo Annals of Transplantation Logo Annals of Transplantation

21 May 2009

Factors predisposing to urinary tract infections in adult kidney allograft recipients with urinary tract reconstruction

J Pazik, E Ważna, Z Lewandowski, A Chmura, S Nazarewski, M Durlik

Ann Transplant 2009; 14(1): 73-74 :: ID: 880470

Abstract

Background: Urinary bladder augmentation or urinary diversion may be necessary for successful kidney transplantation in patients with serious lower urinary tract abnormalities. Reconstruction of urine collecting system may be performed either prior to or at the time of transplantation. Urinary tract infections (UTI) are common in this subset of patients and potentially threatening to graft survival. Aim of the study: To evaluate risk factors of serious, recurrent urinary tract infections (defined as more than one UTI episode requiring hospitalization or urosepsis) in patient with simultaneous to engraftment ileal conduit operation or two-stage surgical protocol.
Material/Methods: In retrospective analysis we identified 24 adult kidney
recipients transplanted between 1999-2008 with severe lower urinary tract
abnormalities requiring reconstruction. In 14 patients ileal loop was created at engraftment, in 7 prior to procedure; 2 patients had continent urine reservoir with Mitrofanoff fistula, 2 bladder augmentation, one cutaneous ureterostomy.
Results: Mean post-transplant follow-up was 33.6±28 month, kidney allograft survival excellent - 97%, and serum creatinine 1.29±0.42 (range 0.9-2.6) mg/dl at the end of observation. Two patients lost their grafts - one kidney was removed because of recurrent bacterial and fungal sepsis, other patient reentered dialysis because of recurrent pyelonephritis. 88% (n=21) of patients had at least one episode of urinary tract infection and 67% (n=16) of them
required in-hospital care. In control group (matched in 1: 3 ration for engraftment date, recipient age and gender) UTI incidence was significantly lower, 44% (n=30), p<0.001. We evaluated the relation between listed parameters and the risk of UTI: recipient gender, living vs. deceased donor, CMV disease, chronic hepatitis, quadruple immunosuppressive regiment, acute rejection episodes, simultaneous with transplantation vs. two stage procedure. The only parameter associated with significantly increased UTI risk was CMV decease (HR 5.9-10, p<0.02
Conclusions: Collecting system reconstruction increases the risk of urinary tract infections (UTI in kidney allograft recipients. We couldn't identify additional, potentially modifiable risk factors of infectious complications. As recipients with urine collecting system abnormalities are on average of small immunological risk, substantial maintenance immunosuppression reduction may help to control infections.

Keywords: Kidney Transplantation

Comments

In Press

06 May 2022 : Original article  

Phosphatidylethanol (PEth) for Monitoring Sobriety in Liver Transplant Candidates: Preliminary Results of D...

Ann Transplant In Press; DOI: 10.12659/AOT.936293  

Most Viewed Current Articles

26 Jan 2022 : Review article  

Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models

DOI :10.12659/AOT.934924

Ann Transplant 2022; 27:e934924

29 Dec 2021 : Original article  

Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...

DOI :10.12659/AOT.933588

Ann Transplant 2021; 26:e933588

24 Jul 2020 : Review article  

Kidney Transplantation in the Times of COVID-19 – A Literature Review

DOI :10.12659/AOT.925755

Ann Transplant 2020; 25:e925755

15 Mar 2022 : Case report  

Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...

DOI :10.12659/AOT.935860

Ann Transplant 2022; 27:e935860

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358