Do Urinary Tract Infections Trigger Chronic Kidney Transplant Rejection in Man?

Müller, Veronika; Becker, Gerold; Delfs, Michael W.; Albrecht, K; Philipp, Thomas; Heemann, Uwe

doi:10.1097/00005392-199806000-00008

Cited by 15 publications

(18 citation statements)

References 11 publications

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“…The effect of early or late UTI after kidney transplantation on graft life and patient mortality has been controversial, with some studies reporting adverse effects of UTI on both parameters (18), whereas other studies did not (16,19). Risk factors for developing UTI after kidney transplantation also have varied among studies.…”

Section: Discussionmentioning

confidence: 99%

Effects of Urinary Tract Infection on Outcomes after Renal Transplantation in Children

Dharnidharka

Agodoa

Abbott

2007

Clinical Journal of the American Society of Nephrology

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Urinary tract infection (UTI) is the most common infection after kidney transplantation.A previous analysis showed that late (>6 mo after transplantation) UTI is associated with earlier graft loss in adults. It was hypothesized that children who are younger than 18 yr would be at higher risk to develop UTI and develop graft loss after both early and late UTI. The US Renal Data System database was analyzed from 1996 to 2000 for Medicare claims (composite of inpatient and outpatient) for UTI up to 36 mo after transplantation. SPSS software and Cox regression models were used to determine association of UTI and age after adjustment for covariates. Early UTI was defined as occurring <6 mo after transplantation, and late UTI was defined as occurring >6 mo after transplantation. The risk for graft loss after early UTI was elevated in all children (adjusted hazard ratio [AHR] 5.47; 95% confidence interval [CI] 1.93 to 15.4; P < 0.001) but not after late UTI (AHR 2.09; 95% CI 0.56 to 7.80; P ‫؍‬ 0.27). Risk for posttransplantation death was not increased significantly after either early UTI (AHR 1.23; 95% CI 0.37 to 4.08) or late UTI (relative risk 2.22; 95% CI 0.90 to 5.44). Boys aged 2 to 5 (versus age 13 to <18 years) were at significantly higher risk for UTI. In girls, only those in the youngest age category (0 to 1) had higher risk for UTI. Children are at greater risk for graft loss after early but not necessarily late UTI. UTI was not an independent predictor of death in this population.Clin J Am Soc Nephrol 2: 100 -106, 2007. doi: 10.2215/CJN.01820506 I n adults, urinary tract infection (UTI) after renal transplantation has been associated with significant morbidity (1). The use of postoperative antibiotic prophylaxis has reduced dramatically the incidence of UTI after renal transplantation in the past few decades (2,3). Nevertheless, the rates of serious posttransplantation complications that are associated with UTI, such as bacterial septicemia, remain high for patients even in the modern era (4). Most centers generally stop antibiotic prophylaxis within 3 to 6 mo after kidney transplantation in adult and pediatric recipients (5). Late posttransplantation UTI (occurring Ͼ6 mo after transplantation) is widely considered to be "benign" on the basis of data from relatively small studies (6,7). However, more recent studies suggest that even late UTI after renal transplantation has definite risks (8). In adults, we demonstrated from a recent large data analysis of the US Renal Data System (USRDS) that late UTI in adult renal transplant recipients is associated with a higher risk for both graft loss and patient death (8); late UTI may not be as benign as previously believed. However, the impact of posttransplantation UTI on outcomes in children may not be identical to the impact in adults.Children have a different distribution of causes of ESRD, such as a high proportion of congenital lesions such as reflux nephropathy or posterior urethral valves. In addition, primary bladder dysfunction frequently is associated wi...

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Section: Discussionmentioning

confidence: 99%

Effects of Urinary Tract Infection on Outcomes after Renal Transplantation in Children

Dharnidharka

Agodoa

Abbott

2007

Clinical Journal of the American Society of Nephrology

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“…It is generally agreed that the increased incidence of infections is proportional to the intensity of immunosuppressant therapy (23)(24)(25). Müller et al (23) reported that transplanted patients displaying chronic rejection had more UTIs than those displaying no apparent signs of rejection. In contrast, Giral et al (11) reported that rejection episodes do not constitute a risk factor for APN.…”

Section: Long-term Kidney Graft Functionmentioning

confidence: 99%

Acute Pyelonephritis Represents a Risk Factor Impairing Long-Term Kidney Graft Function

Pellé

Vimont

Lévy

et al. 2007

American Journal of Transplantation

269

217

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Urinary tract infections (UTIs) and acute pyelonephritis (APN) often occur after renal transplantation, but their impact on graft outcome is unclear. One hundred and seventy-seven consecutive renal transplantations were investigated to evaluate the impact of UTIs and APN on graft function. The cumulative incidence of UTIs was 75.1% and that of APN was 18.7%. UTIs occurred mainly during the first year after transplantation and Escherichia coli, Pseudomonas aeruginosa and Enteroccocus sp. were the most frequent pathogens identified. The risk of developing APN was higher in female (64%) than in male recipients, and was correlated with the frequency of recurrent UTIs (p < 0.0001) and rejection episodes (p = 0.0003). APN did not alter graft or recipient survival, however, compared to patients with uncomplicated UTIs, patients with APN exhibited both a significant increase in serum creatinine and a decrease in creatinine clearance, already detected after 1 year (aMDRD-GFR: APN: 39.5 ± 12.5; uncomplicated UTI: 54.6 ± 21.7 mL/min/1.73 m 2 , p < 0.01) and still persistent (∼ − 50%) 4 years after transplantation. Multivariate analysis revealed that APN represents an independent risk factor associated with the decline of renal function (p = 0.034). Therefore, APN may be associated with an enduring decrease in renal graft function.

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“…, rejection (8) and recurrent UTI (5,9 Figure 1) (4,(10)(11)(12)(13)(14) (17,18). In addition, a subset of O antigen serotypes are present on the majority (80%) of E. coli isolates from patients with UTI (11,19 (20).…”

Section: Urinary Tract Infection (Uti) Is the Most Common Infection Imentioning

confidence: 99%

Urinary Tract Infections in Solid Organ Transplant Recipients

Rice

Safdar

2009

American Journal of Transplantation

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Epidemiology Urinary tract infection (UTI) is the most common infection in the renal Enterobacter and other organisms (group B streptococci, and Gardnerella vaginalis) also occurring (Figure 1) (4,(10)(11)(12)(13)(14) UTI and pyelonephritis (24,25). Vesico-ureteral reflux (VUR) majority of pyelonephritis isolates from immunosuppressed patients (17,18). In addition, a subset of O antigen serotypes are present on the majority (80%) of E. coli isolates from patients with UTI (11,19). Although most studies document a decreased prevalence of virulence factors expressed by uropathogenic E. coli from compromised hosts, likely reflecting the weaker barriers to infection in this population (17), a recent report suggests that unique patterns of uropathogenic of O:H serotypes and P fimbriae adherence factor among E. coli isolates from renal transplant patients with UTI (20). Risk factors

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Do Urinary Tract Infections Trigger Chronic Kidney Transplant Rejection in Man?

Abstract: Urinary tract infections are an important risk factor for the onset of chronic rejection, and early and intense treatment is critical.

Cited by 15 publications

References 11 publications

Effects of Urinary Tract Infection on Outcomes after Renal Transplantation in Children

Effects of Urinary Tract Infection on Outcomes after Renal Transplantation in Children

Acute Pyelonephritis Represents a Risk Factor Impairing Long-Term Kidney Graft Function

Urinary Tract Infections in Solid Organ Transplant Recipients

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