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

Abstract

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...

Urinary tract infection following kidney transplantation: frequency, risk factors and graft function

“…In our study, as in most others, younger age at transplantation was associated with post-KTx UTI [4,5,15]. Similarly, an age of <5 years persisted as a risk factor for post-KTx UTI and multiple episodes of post-KTx UTI.…”

“…While several studies have reported a rise in serum creatinine during post-KTx UTI, including asymptomatic episodes, reports describing the impact of UTI on long-term graft function have been inconsistent to date [3][4][5][6]. UTI is presumed to impair long-term graft function by predisposing to graft rejection, initially through interstitial inflammation and subsequently through fibrosis.…”

Assessing the Value of Ureteral Stent Placement in Pediatric Kidney Transplant Recipients

“…Stenosis or leakages would be likely to threaten graft function and need immediate surgical intervention, with likely catastrophic consequences if not corrected. In contrast, an early UTI episode, though potentially graft-threatening in children (17), can often be treated to full resolution by medical means. BKVAN represents a significant risk factor for accelerated graft loss, probably more so than a single UTI episode, but can occur at varying time points after transplant.…”

Study of the risk factors related to acquisition of urinary tract infections in patients submitted to renal transplant

“…These infections may be associated with allograft dysfunction and can predispose patients to the development of acute allograft rejection (11) (12) (13) .…”