Incidence of and Risk Factors for Recurrent Urinary Tract Infections in Renal Transplant Recipients

Halskov, Anna C.L.; Dagnæs-Hansen, Julia; Stroomberg, Hein Vincent; Sørensen, Søren Schwartz; Røder, Martin Andreas

doi:10.1016/j.euros.2023.04.001

Cited by 4 publications

(5 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The inconsistency in findings among studies may be due to variations in study populations, methodology, and most importantly age category definitions [ 25 ▪▪ ]. To sum up increasing age was confirmed as significant risk factor in six studies [ 3 ▪▪ , 11 ▪▪ , 22 ▪▪ , 23 ▪▪ , 25 ▪▪ , 28 ] comparing to three [ 24 , 29 , 30 ] studies failing to prove this association.…”

Section: Influence Of Age On Urinary Tract Infectionsmentioning

confidence: 99%

“…Age has an effect that goes beyond the first posttransplant phase and may have an impact on the long-term course of infectious problems [ 21 ]. Acknowledging age as a major factor influencing the incidence of UTIs is essential for customizing prophylactic measures and maximizing posttransplant care to improve short- and long-term results in this susceptible population [ 3 ▪▪ ]. This has been well investigated in a work from Brazil in 2022, where, in line with the later studies, higher age was associated with an increased risk for more UTIs (approximate risk of UTI of 3.6% per year of age) [ 22 ▪▪ ].…”

Section: Influence Of Age On Urinary Tract Infectionsmentioning

confidence: 99%

“…In the context of aging, it is of note that half of the eligible kidney transplant (KTX) patients comprises individuals over the age of 65, yet only a small fraction of patients with end-stage renal disease in this age makes it onto the European renal transplant waiting lists [ 1 , 2 ▪▪ ]. As older patients increasingly become recipient of renal allografts, the evidence and recommendations regarding the management of posttransplant complications, such as urinary tract infections (UTIs) and ureter leaks, have to be reassessed for this specific patient group [ 3 ▪▪ , 4 ]. Research indicates that placing a ureteric stent (UrS) through the vesicoureteral anastomosis during the operation significantly reduces the likelihood of complications such as urine leak, vesicoureteral reflux, stricture, and ureteric obstruction [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

Omic,

Eder

2024

Current Opinion in Urology

View full text Add to dashboard Cite

Purpose of review This review aims to present the recent literature regarding effects of aging and ureteral stent implantation (UrS) on the risk of urinary tract infections (UTIs) in kidney transplant (KTX) recipients. Recent findings UTIs in kidney transplant recipients remain a clinical challenge and represent a leading cause of morbidity, hospitalization rates, and mortality. Higher age was described as a significant risk factor for UTIs in several studies including a recent Brazilian analysis, indicating a 3.6%/years of age increase in UTI risk. Subsequently, a large meta-analysis, published in 2023, confirmed the correlation between older age and elevated UTI risk. The Swiss Transplant Cohort Study in 2022, largest of its kind, similarly confirmed a link between advanced age and heightened risk of recurrent UTIs in KTX. A recent prospective study highlighted UrS placement as a modifiable risk factor, emphasizing the need for careful consideration and antibiotic prophylaxis. Additionally, the type of stents played a crucial role, with external stents associated with a 1.69 times higher UTI risk. The challenge of determining optimal UrS removal timing further complicates posttransplant care, with insufficient evidence to guide practices. Summary The aging population of KTX recipients requires a personalized approach to effectively reduce and manage UTIs as one of the most important complications following KTX. Prophylactic stent implantation is successful in lowering ureteral complications, however, is associated with an increased incidence of UTIs. To reduce the increased risk of UTIs, the length of stent insertion requires strict supervision and maintenance.

show abstract

Section: Influence Of Age On Urinary Tract Infectionsmentioning

confidence: 99%

Section: Influence Of Age On Urinary Tract Infectionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

Omic,

Eder

2024

Current Opinion in Urology

View full text Add to dashboard Cite

show abstract

“…They rarely affect graft survival but often require intervention, which is of great cost to both patients and the healthcare system. Recurrent urinary tract infections are a frequent, long-term complication of kidney transplantation (27). Short-and long-term mortality rates are essential to monitor in any interventional trial.…”

Section: Late Complicationsmentioning

confidence: 99%

Open-label randomised clinical trial investigating whether Robot-Assisted Kidney Transplantation can reduce surgical complications compared to Open Kidney Transplantation (ORAKTx): Study protocol for a randomised clinical trial

Ortved,

Dagnæs-Hansen,

Stroomberg

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Kidney transplantation is the ultimate treatment for end-stage kidney disease. Function of the kidney graft is not only dependent on medical factors but also a complication-free surgical procedure. In the event of major surgical complications, the kidney graft is potentially lost and the patient will return to the waiting list which may be long. To optimise peri-operative care and reduce complications, robot-assisted kidney transplantation (RAKT) has been introduced as an alternative to open kidney transplantation (OKT), but to our knowledge no randomised clinical trials are comparing RAKT to OKT. We will explore whether robot-assisted surgery can reduce 30-day surgical complications compared to open surgery in kidney transplantation. Methods: This a single-site, open-label, randomised clinical trial comparing RAKT to OKT. Participants are adult recipients of kidney transplantation and all participants are recruited from Copenhagen University Hospital – Rigshospitalet, Denmark. The study plans to include 106 participants who will be randomised in a 1:1 manner between OKT and RAKT. Primary outcomes are vascular- and major surgical complications at 30 days post-operatively. Participants will be followed for two years to evaluate secondary outcomes including recovery, late complications and kidney graft function. This is designed as a superiority trial and planned analyses are as intention-to-treat. Discussion: Studies indicate RAKT can reduce several surgical complications, but the lack of RCTs limits the extrapolation of these results to justify the replacement of an open approach with a robot-assisted one. Ultimately, the introduction of new surgical techniques should be as vigorously tested as any other new treatments. However, reducing surgical complications that compromise graft viability could lead to improved patient care and survival. Trial registration: The trial was prospectively registered on February 15th 2023 on clinicaltrials.gov with NCT-identifier 05730257.

show abstract

“…An algorithm published by Mitra et al indicates video UDS for work-up of bladder dysfunction, BOO, or vesicoureteral reflux (VUR) after structural abnormalities have been ruled out by US and computed tomography (CT) [65]. In a contemporary retrospective review, Halskov et al looked at 571 KT patients between 2014 and 2021 to identify the incidence of recurrent UTIs and associated risk factors in order to understand impact on patient and graft survival [66]. In this Denmark cohort, 18% had recurrent UTIs, defined as ≥ 3 cultureverified UTIs within a year.…”

Section: Post-transplant Evaluationmentioning

confidence: 99%

Urodynamics in the Transplant Population

Lee,

Van Kuiken

2024

Curr Bladder Dysfunct Rep

View full text Add to dashboard Cite

Purpose of Review Urodynamic testing (UDS) is a valuable tool for understanding the safety of the lower urinary tract (LUT). The goal of this review is to provide evidence-based indications for use of UDS in both the pre-and post-kidney transplant (KT) settings. Recent Findings Pre-transplant bladder cycling with UDS for anuric or oliguric patients is no longer recommended. Instead, UDS aids in identifying LUT anomalies that may require optimization prior to transplant, especially in patients with known urologic etiologies of end-stage renal disease (ERSD). In pre-KT patients with recurrent urinary tract infections (UTIs) or prior urologic/pelvic interventions, UDS should be used judiciously when the etiology of LUT dysfunction is unclear. In the post-transplant setting, urologists are often consulted for LUT symptoms (LUTS), hydronephrosis, urinary retention, declining renal function, and most commonly, recurrent UTI. Again, UDS should not be routinely performed first line, but as an adjunct to distinguish similarly presenting LUT etiologies such as bladder outlet obstruction (BOO) and bladder dysfunction. Summary UDS remains the gold standard for characterizing the LUT, and when utilized appropriately, can identify factors promoting graft and patient survival after KT.

show abstract

Incidence of and Risk Factors for Recurrent Urinary Tract Infections in Renal Transplant Recipients

Cited by 4 publications

References 30 publications

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

Open-label randomised clinical trial investigating whether Robot-Assisted Kidney Transplantation can reduce surgical complications compared to Open Kidney Transplantation (ORAKTx): Study protocol for a randomised clinical trial

Urodynamics in the Transplant Population

Contact Info

Product

Resources

About