Urinary tract infections after renal transplantation

Abstract

Up to now one of the major problems for successful organ transplantation has been the reaction of the immune system of the recipient against the donor organ. This could lead to acute and chronic rejection, and in cases of unsuccessful treatment to the loss of the transplant. In organ graft recipients, immunosuppressive agents are used to prevent or treat rejection episodes and to maintain graft function. Although there is an increasing number of immunosuppressive substances, the immunosuppressive therapy currently in use is relatively unspecific and targets many immunological functions. The net state of immunosuppression is a complex function determined by the interaction of a number of factors, the most important of these are the dose, duration and temporal sequence in which immunosuppressive drugs are employed. Any kind of immunosuppressive protocol is thus associated with an increased infection rate. This has an important socioecological impact, because frequent hospitalizations resulting from infectious complications are necessary, having an overall mortality rate of 3.5% within 2 weeks of admission. The most common cause of septicaemia is urinary tract infection. Frequent urinary tract infections are associated with the early onset of chronic rejection, suggesting a pathogenetic relationship between these two features. The occurrence of chronic rejection has led to reduced transplant survival. The prevention of urinary tract infections, or the early diagnosis and accurate treatment of urinary tract infections is important in renal transplant recipients.

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

“…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).…”

Culture-Independent Identification of Pathogenic Bacteria and Polymicrobial Infections in the Genitourinary Tract of Renal Transplant Recipients

“…The incidence of bacterial infection in renal transplant recipients is directly related to the net immunosuppressive effect achieved and the duration of time over which this therapy is administered. Bacterial urinary tract infections (UTIs) are frequently associated with the early onset of chronic rejection and may also lead to reduced transplant survival (15,18). Studies have shown that in 40 to 60% of transplant recipients the urinary tract is the source of septicemia and that in patients with urosepsis the recurrence rate was approximately 40% (1,13).…”

Bacterial agents of Urinary tract infection in renal allograft recipients and their antimicrobial resistance pattern.

“…Differences in the definition of UTI, follow-up period, time of testing and the use of antimicrobial prophylaxis may explain this wide range 3 . Previously bacterial agents isolated from renal transplant recipients with UTI were almost similar to those causing UTI in the general population 4 . In Bangabandhu Sheikh Mujib Medical University (BSMMU) over a period of 2 years from January 2002 to December 2003 Islam et al 5 studied 31 post renal transplant patients of which 51 episodes of bacterial infection occur.…”