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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2012  |  Volume : 23  |  Issue : 4  |  Page : 832-833
Urinary tract infection in the kidney allograft recipients


University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka

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Date of Web Publication9-Jul-2012
 

How to cite this article:
Rathnamalala N K. Urinary tract infection in the kidney allograft recipients. Saudi J Kidney Dis Transpl 2012;23:832-3

How to cite this URL:
Rathnamalala N K. Urinary tract infection in the kidney allograft recipients. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2019 Sep 16];23:832-3. Available from: http://www.sjkdt.org/text.asp?2012/23/4/832/98174
To the Editor,

Urinary tract infection (UTI) accounts for 40-50% of all infections in the kidney trans­plant recipient, with an incidence between 6 and 86%. [1],[2],[3],[4] There has been a decline in the rate of UTI in transplants over the past 30 years. Pubmed was searched for articles using the key words, "Post Transplant and Urinary Tract Infection." The key words were kept less specific to retrieve a larger percentage of relevant articles. Only English articles were perused. The cited references were selected based on relevance and scientific quality.

Many factors are implicated in the pathogenesis of UTI following renal transplantation. Studies have shown that the risk of UTI is highest during the early transplant period, [6] especially the first three months post-kidney transplantation. [7] High incidence of UTI was directly proportional to the duration of bladder catheterization following surgery. [8] An incidence of 22% for UTI was also observed in the kidney transplant patients with stents, [9] which was not substantiated by others. [10]

Female gender is associated with a high inci­dence of UTI post kidney transplantation, [10],[11] as is diabetes. [12] Higher doses of steroids and azathioprine-based regimes and the use of anti-thymocytic globulin as an immunosuppressive induction agent have shown a positive asso­ciation with UTI, especially at six months and thereafter. [8],[13] Many studies have also demons­trated that UTI is more common in the patients receiving deceased donor kidneys. [8]

Anatomical abnormalities of the native renal tract are also associated with post-transplant UTI. These include primary vesicoureteric reflux, polycycstic kidney disease and hydo-nephrotic kidneys. Post-transplant vesicoureteric reflux may be present in up to 61.3% of the transplant recipients, and advanced grade was detected in 40%. [14] This may be an impor­tant underlying pathology for post-transplant UTI that may often be under-diagnosed. Ureteric obstruction in the transplant recipient is also a commonly encountered anatomical ab­normality, which requires intervention to pre­vent UTI and graft dysfunction.

Gram negative organisms have shown a uni­versal uniformity in post-transplant UTI.  Escherichia More Details coli and enterobacter species are the most commonly reported, with an incidence varying between 30 and 60%. [5],[7],[8],[15],[16] Other organisms reported are Staphylococcus sp., Streptococcus sp, Klebsiella, Pseudomonas and Proteus mirabilis. Fungal UTI with Candida albicans has also been reported, and is mostly seen among diabetics.

Treatment of post-transplant UTI is similar to that in those with native kidneys. The presence of features suggestive of acute graft pyelo­nephritis warrants intravenous antibiotic treat­ment for ten to 14 days. However, the drug interactions with immunosuppressive agents such as cyclosporine should be born in mind when choosing an antibiotic. Ureteric stents should be removed early in the presence of a UTI. Fungal UTI should be treated with syste­mic antifungals such as fluconazole or amphotericin B. [17]

The recurrence rate of post-transplant UTI is between 39 and 73%. Studies have demonstrated that cotrimoxazole prohylaxis used for the Pneumocystis jiroveci infection reduced the incidence of UTI. [11],[16] However, it is still un­clear whether all patients should receive pro­phylaxis, especially given the development of resistance and drug interactions with cyclosporine.

In conclusion, post-transplant UTI in the kid­ney allograft recipient may lead to compli­cations such as sepsis and death. There is also evidence to support that UTI may have an adverse effect on long-term graft function. Therefore, it is imperative to minimize the occurrence of UTI in this group. Although high-dose cotrimoxazole seems promising for the prevention of post-transplant UTI, larger studies are warranted. Risk factor reduction and adequate treatment are the current options available to minimize the harm.

 
   References Top

1.Rubin RH. Infectious disease complications of renal transplantation. Kidney Int 1993;44:221-36.  Back to cited text no. 1
[PUBMED]    
2.Karakayali H, Emiroulu R, Arslan G, Bilgin N, Haberal M. Major infectious complications after kidney transplantation. Transplant Proc 2001;33: 1816-7.  Back to cited text no. 2
    
3.Giral M, Pascuariello G, Karam G, et al. Acute graft pyelonephritis and long-term kidney allograft outcome. Kidney Int 2002;61:1880-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Chuang P, Parikh CR, Langone A. Urinary tract infections after renal transplantation: A retros­pective review at two US transplant centers. Clin Transplant 2005;19:230-5.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Alangaden GJ, Thyagarajan R, Gruber SA, et al. Infectious complications after kidney transplan­tation: current epidemiology and associated risk factors. Clin Transplant 2006;20:401-9.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Prat V, Horcickoya M, Matousovic K, Hatala M, Liska M. Urinary tract infection in renal transplant patients. Infection 1985;13:207-10.  Back to cited text no. 6
    
7.Sqalli TH, Laboudi A, Arrrayhani M, et al. Urinary Tract Infection in renal allograft reci­pients from living related donors. Saudi J Kidney Dis Transpl 2008;19:551-3.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Dantas SR, Kuboyama RH, Mazzali M, Moretti ML. Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect 2006;63:117-23.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Glazier DB, Jacobs MG, Lyman NW, Whang MI, Manor E, Mulgaonkar SP. Urinary tract infection associated with ureteral stents in renal transplan­tation. Can J Urol 1998;5:462-6.  Back to cited text no. 9
[PUBMED]    
10.Mathe Z, Treckmann JW, Heuer M, et al. Stented ureterovesical anastomosis in renal transplan­tation: does it influence the rate of urinary tract infections? Eur J Med Res 2010;15:297-302.  Back to cited text no. 10
    
11.Khosroshahi HT, Mogaddam AN, Shoja MM. Efficacy of high dose trimethoprim- sulfamethoxazole prophylaxis on early urinary tract infection after transplantation. Transplant Proc 2006;38:2062-4.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  
12.Lansang MC, Ma L, Schold JD, Meier-Kriesche HU, Kaplan B. The relationship between diabetes and infectious hospitalizations in renal transplant recipients. Diabetes Care 2006;29:1659-60.  Back to cited text no. 12
[PUBMED]  [FULLTEXT]  
13.Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D. Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 2006;355:1967-77.  Back to cited text no. 13
    
14.Jung GO, Chun JM, Park JB, et al. Clinical signi­ficance of posttransplantation vesicoureteral reflux during short-term period after kidney transplantation. Transplant Proc 2008;40:2339-41.  Back to cited text no. 14
[PUBMED]  [FULLTEXT]  
15.Alexopoulos E, Memmos D, Sakellariou G, Paschalidou E, Kyrou A, Papadimitriou M. Urinary tract infections after renal transplan­tation. Drugs Exp Clin Res 1985;11:101-5.  Back to cited text no. 15
[PUBMED]    
16.Khanna P, Abraham G, Mohamed Ali AA, et al. Urinary tract infections in the era of newer immunosuppressant agents: A tertiary care center study. Saudi J Kidney Dis Transpl 2010;21:876-80.  Back to cited text no. 16
[PUBMED]  Medknow Journal  
17.De Souza RM, Olsburgh J. Urinary tract infection in the renal transplant patient. Nature Clin Pract Nephrol 2008;4:252-64.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
N K Rathnamalala
University Medical Unit, National Hospital of Sri Lanka, Colombo
Sri Lanka
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DOI: 10.4103/1319-2442.98174

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