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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 4  |  Page : 551-553
Urinary Tract Infections in Renal Allograft Recipients from Living Related Donors


Department of Nephrology, Ibn Sina University Hospital, Rabat, Morocco

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   Abstract 

Urinary tract infection (UTI) remains the most common infectious complication in renal transplant recipients. We aimed in our study to describe the epidemiological patterns and evaluate the favouring factors of UTI in our renal allograft recipients. We evaluated retrospectively all the UTIs in 47 kidney recipients transplanted from living-related kidney donors in Rabat University Hospital, Morocco, from January 1998 to December 2005. The mean follow-up was 28 ± 19 months. The mean age of the patients was 32 ± 10 years with a male/female ratio of 1.35/1. Twenty patients (42%) suffered at least one UTI episode. UTIs were asymptomatic in 70% of the patients, while manifested as acute pyelonephritis in 17% and uncomplicated acute bacterial cystitis in 13%. UTI episodes occurred in 68% of the patients during the first 3 months post­kidney transplantation with a recurrence rate of 55%, and all the patients experienced a favourable course. Gram-negative bacilli were the principally isolated agents; E. Coli was found in 60% of the patients and Klebsiella in 30%. UTI was more common in females (p = 0.04) and cases of post transplantation vesicoureteral reflux (p = 0.03). The graft survival rate at the end of the study was comparable for both UTI and non-UTI groups.

Keywords: Urinary, Tract, Infection, Renal, Transplantation, Pyelonephritis

How to cite this article:
Sqalli TH, Laboudi A, Arrayhani M, Benamar L, Amar Y, Ouzeddoun N, Bayahia R, Rhou H. Urinary Tract Infections in Renal Allograft Recipients from Living Related Donors. Saudi J Kidney Dis Transpl 2008;19:551-3

How to cite this URL:
Sqalli TH, Laboudi A, Arrayhani M, Benamar L, Amar Y, Ouzeddoun N, Bayahia R, Rhou H. Urinary Tract Infections in Renal Allograft Recipients from Living Related Donors. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Jan 29];19:551-3. Available from: http://www.sjkdt.org/text.asp?2008/19/4/551/41312

   Introduction Top


UTI is the most frequent post transplan­tation infection. [1],[2] It remains a major pro­blem despite the significant advances in surgical techniques and immunosuppressive therapy.

We aim in our study to describe the epi­demiological patterns and evaluate the favouring factors of UTI in our renal allo­graft recipients.


   Patients and Methods Top


We evaluated retrospectively all the UTIs in 47 patients with transplanted allografts from living-related kidney donors in Rabat University Hospital, Morocco, from January 1998 to December 2005. The ureters of the allografts were anastomosed to the bladders of the recipients using Lich-Gregoire me­thod, and double J ureteral stents were placed at time of transplantation and removed three weeks postoperatively. The recipients did not receive induction immunosuppressive therapy, but were maintained on cyclospo­rine, prednisone, and either mycophenolate mofetil (40%) or azathioprine (60%). All patients received prophylaxis for UTIs with sulfadoxine-pyrimethamine for three months after transplantation.

UTI was defined as a urine culture con­taining more than 10 6 colonies, while acute pyelonephritis was defined as UTI with fever.

We recorded the following variables: demo­graphic data, cause and date of transplanta­tion, infectious background of recipients, immunosuppressive treatment, causative micro-organism of UTI, and graft survival.


   Statistical Analysis Top


Statistical analysis was performed with SPSS (version 12.0, SPSS, Chicago, Ill). Parameters were expressed in percentage (%) and mean ± standard deviation. The chi-square test was used to compare the cross-tabulated categorical data, while for the quantitative data we used the inde­pendent samples "t" test. A p value <0.05 was considered as significant.


   Results Top


We studied 47 renal allograft recipients, with a mean follow-up of 28 ± 19 (range 11 - 84) months. The mean age of the patients was 32 ± 10 years with a male/female ratio of 1.35/1. The causes of the original disease in recipients included vesicoureteral reflux in 7 (15%) cases, glomerulonephropathy in 7 (15%), diabetes mellitus in 2 (4%), and unknown cause in 31 (66%).

Twenty (42%) patients suffered at least one UTI episode with 40 confirmed attacks. UTIs were asymptomatic in 70% of the patients, while manifested as acute pyelo­nephritis in 17% and uncomplicated acute bacterial cystitis in 13%. UTI episodes occurred in 68% of the patients during the first 3 months post-kidney transplantation with a recurrence rate of 55%. Micro­biological isolation was confirmed in all episodes. Gram-negative bacilli were the principally isolated agents; E. Coli was found in 60% of the patients and Klebsiella in 30%. Other causative micro-organisms included enterobacteries, pseudomonas, and strep­tococcus.

The antibiotics used in the treatment of the UTIs included Fluoroquinolones (60%), amoxicillin and clavulanic acid (30%), tri­methoprim-sulfamethoxazol (10%), and third generation cephalosporin (20%). All epi­sodes showed a favorable course. All the pyelonephritis episodes recovered without a relapse or any consequences.

UTI was more common in females (p = 0.04) and cases of post transplantation vesicoureteral reflux (p = 0.03) [Table 1]. The graft survival rate at the end of the study was comparable for both UTI and non-UTI groups.


   Discussion Top


Prevalence of UTI was 42% in our study. Most UTI episodes occur during the first 3 months post kidney transplantation, whish is considered a critical period of time with the use of high doses of immunosuppre­ssive therapy, and urinary manipulations such as ureteral stents, and Foley's cathe­ters. [3]  Escherichia More Details coli and Enterococcus spp. were the most prevalent uropathogens in our study as reported elsewhere. [2]

This study shows that female gender and vesicoureteral reflux were the main risk factors for UTI. In other studies, Retrans­plantation and ureteral stents were inde­pendently associated with UTI. [1]

The use of newer immunosuppressive agents (Sirolimus, thymoglobulin) in recent years has been associated with some changes in the epidemiology of post-transplant infec­tions; Enterococci have become more pre­valent. [1],[4]

Despite a high recurring infection rate, uncomplicated UTI demonstrated a good graft prognosis in the recipients of renal allografts from living donors. [5],[6] This is most likely due to antibiotic prophylactic therapy for UTI and less required immunosuppre­ssive therapy ( induction and maintenance) than the renal allografts from the deceased donors.

We conclude that UTI is a common com­plication in the early post renal transplant period in the renal allografts from living donors that requires antibiotic prophylactic therapy and close surveillance, however, has a good prognosis.

 
   References Top

1.Valera B, Gentil MA, Cabello V, Fijo J, Cordero E, Cisneros JM. Epidemiology of urinary infections in renal transplant recipients. Transplant Proc 2006;38(8): 2414-5.  Back to cited text no. 1    
2.Alangaden GJ, Thyagarajan R, Gruber SA, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant 2006;20(4):401-9.  Back to cited text no. 2    
3.Khosroshahi HT, Mogaddam AN, Shoja MM. Efficacy of high-dose trimethoprim­sulfamethoxazol prophylaxis on early urinary tract infection after renal trans­plantation. Transplant Proc 2006;38(7): 2062-4.  Back to cited text no. 3    
4.Kamath NS, John GT, Neelakantan N, Kirubakaran MG, Jacob CK. Acute graft pyelonephritis following renal transplan­tation. Transpl Infect Dis 2006;8(3):140-7.  Back to cited text no. 4    
5.Cepeda PA, Balderramo DC, De Arteaga J, Douthat WG, Massari PU. Early urinary tract infection in kidney transplantation. Risk factors and impact on graft survival. Medicina (B Aires) 2005;65(5):409-14.  Back to cited text no. 5    
6.Ferraresso M, Berardinelli L. Nosocomial infection in kidney transplant recipients: a retrospective analysis of a single-center experience. Transplant Proc 2005;37(6): 2495-6.  Back to cited text no. 6    

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Correspondence Address:
Tarik Houssaini Sqalli
Department of Nephrology, Ibn Sina University Hospital, Rabat
Morocco
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PMID: 18580011

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    Tables

  [Table 1]

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    Abstract
    Introduction
    Patients and Methods
    Statistical Analysis
    Results
    Discussion
    References
    Article Tables
 

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