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| Year : 2008 | Volume
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| Issue : 4 | Page : 551-553 |
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| Urinary Tract Infections in Renal Allograft Recipients from Living Related Donors |
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Tarik Houssaini Sqalli, Asmaa Laboudi, Mohamed Arrayhani, Loubna Benamar, Yamama Amar, Naima Ouzeddoun, Rabea Bayahia, Hakima Rhou
Department of Nephrology, Ibn Sina University Hospital, Rabat, Morocco
Click here for correspondence address and email
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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 Nov 23];19:551-3. Available from: https://www.sjkdt.org/text.asp?2008/19/4/551/41312 |
| Introduction | |  |
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 | | |
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 | | |
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 | | |
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 | | |
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 | | |
| 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.  |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
Correspondence Address:
Tarik Houssaini Sqalli
Department of Nephrology, Ibn Sina University Hospital, Rabat
Morocco
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PMID: 18580011 
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