Influence of Graft Ureter Length, a Donor-Related Factor, on Urinary Tract Infections After Living-Donor Kidney Transplantation: A Single-Center Analysis of 211 Cases

Abstract

Urinary tract infection (UTI) occurs in 25% of recipients of living-donor kidney transplantation (LDKT). Female sex, age, and anatomical abnormalities have been reported as recipient-related risk factors for UTI after LDKT; few studies have reported donor-related factors. We retrospectively examined UTI occurrence within 5 years of transplantation in recipients (n = 211) who underwent LDKT at our hospital between April 2011 and April 2021. All nephrectomies were performed using a retroperitoneal pure laparoscopic approach. The ureter was dissected at the lower level of the common iliac artery and trimmed to the shortest length, enough to reach the bladder using extra vesicular ureterocystoneostomy with a 3 cm submucosal tunnel. Twenty-nine recipients (13.7%) developed UTI within 5 years, and the median time to onset was 40.0 days. After adjusting for the well-known factors, including recipient sex, graft ureter length was an independent factor for UTI occurrence (HR 1.25, 95% CI 1.02∼1.53, p = 0.028) in the multivariate Cox regression analysis. The long ureter is usually trimmed, and the widest part is used for anastomosis, which may increase the possibility of reflux from the bladder to the ureter in the standard technique. The ureter length may be associated with the incidence of UTI after LDKT.

Differences in the composition of the bacterial element of the urinary tract microbiome in patients undergoing dialysis and patients after kidney transplantation

“…Urinary tract infection (UTI) is a serious problem in patients with chronic kidney disease (CKD), especially in individuals undergoing dialysis or kidney transplant ( Grabe et al, 2015 ; Coussement et al, 2020 ). UTI is associated with increased risks of acute rejection, allograft dysfunction, graft loss, increased hospital stays, and mortality ( Ariza-Heredia et al, 2014 ; Koga et al, 2022 ). Furthermore, a recurrent UTI, which occurs in 7% of the patients after kidney transplantation, is one of the leading causes of allograft loss and death ( Britt et al, 2017 ).…”

Urinary tract infection in the context of mini-invasive procedures after kidney transplantation

“…The underlying disease as a risk factor for a positive urine fi nding at the time of pig-tail extraction was not confi rmed either in our analysis or in the study of Lee et al ( 4). An interesting result came from the study by Koga et al from 2022, where the occurrence of IMT may be related to the length and diameter of the kidney ureter from a living donor (17).…”