Urinary Tract Infections and Bladder Dysfunction After Renal Transplantation in Children

Herthelius, Maria; Öborn, Helena

doi:10.1016/j.juro.2007.01.054

Cited by 39 publications

(32 citation statements)

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“…In a meta-analysis, Green et al [42] reported that antibiotic prophylaxis reduced the sepsis with bacteraemia by 87% and the bacteriuria by 60%. Herthelius et al [36] reported that the incidence of recurrent UTIs was 35 and 42% in recipients with and without bladder dysfunction, respectively, in a study in 68 children after a mean follow-up of 6 years. This difference was not significant.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

et al. 2015

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ObjectivesTo compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. Patients and MethodsA database of children (<18 years old) who underwent RTx between May 2008 and April 2012 was reviewed. Patients were divided into those with LUTD (group A, n = 29) and those with other causes of ESRD (group B, n = 74). RTx was performed after achieving low intravesical pressure (<30 cmH 2 O) with adequate bladder capacity and drainage. The groups were compared using Student's t-test, MannWhitney, chi-squared or exact tests. Graft survival rates (GSRs) were evaluated using Kaplan-Meier curves and the log-rank test. ResultsThe mean AE SD (range) age of the study cohort was 5.05 AE 12.4 (2.2-18) years. Causes of LUTD were posterior urethral valve (PUV; 41.4%), vesico-ureteric reflux (VUR; 37.9%), neurogenic bladder (10.3%), prune belly syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration or donor type. In group A, 25 of the 29 patients (86.2%) underwent ≥1 surgery to optimize the urinary tract for allograft. Pretransplant nephrectomy was performed in 15 of the 29 patients (51.7%), PUV ablation in nine patients (31%) and ileocystoplasty in four patients (13.7%). The mean AE SD follow-up was 4.52 AE 1.55 and 4.07 AE 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between the groups at different points of follow-up. The GSRs at the end of the study were 93.1 and 91.1% in groups A and B, respectively (P = 1.00). According to Kaplan-Meier survival curves, there was no significant difference in the GSR between the groups using the log-rank test (P = 0.503). No graft was lost as a result of urological complications. In group B, one child died from septicaemia. The rate of urinary tract infections was 24 and 12% in groups A and B, respectively, but was not significant. No significant difference was found between the groups with regard to the incidence of post-transplantation hydronephrosis. Of the 22 patients who had hydronephrosis after transplantation, three were complicated by UTI. Injection of bulking agents was required in two patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. ConclusionAcceptable graft function, survival and UTI rates can be achieved in children with ESRD attributable to LUTD. Thorough assessment and optimization of LUT, together with close follow-up, are key for successful RTx.

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Section: Discussionmentioning

confidence: 99%

“…They are the most common form of bacterial infections after RTx [36][37][38][39]. Some authors found no influence of UTI on graft survival [16,40], while others have stated that febrile infectious episodes may have an adverse impact on long-term renal graft function [41].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

et al. 2015

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“…Similarly, a two-centre study failed to document any difference in serum creatinine after a follow-up time of 3.3 years between a cohort of children who had one or more episode of UTI post-KTx and those who did not [3]. Some researchers have suggested that post-KTx UTI adversely affects graft function and that the failure to detect a difference in graft function between a group of children who developed post-KTx UTI and those who did not may be due to the poor sensitivity of serum creatinine as a marker for detecting decreased GFR [6,19]. Using inulin and iohexol, Herthelius and Oborn reported that having more than one episode of post-KTx UTI was associated with decreased graft function [19].…”

Section: Discussionmentioning

confidence: 99%

“…Some researchers have suggested that post-KTx UTI adversely affects graft function and that the failure to detect a difference in graft function between a group of children who developed post-KTx UTI and those who did not may be due to the poor sensitivity of serum creatinine as a marker for detecting decreased GFR [6,19]. Using inulin and iohexol, Herthelius and Oborn reported that having more than one episode of post-KTx UTI was associated with decreased graft function [19]. Our inability to detect a difference in the most recent serum creatinine between the two groups of children may also be due to the high number of non-E. coli UTI.…”

Section: Discussionmentioning

confidence: 99%

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

2011

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The aim of this study was to determine the proportion of children who develop urinary tract infection (UTI) after kidney transplantation (KTx) and to identify the factors associated with UTI and its impact on graft function. To this end, we undertook a chart review of children who underwent KTx at Red Cross Children's Hospital between January 2003 and December 2009 and were followed-up for at least 6 months after transplantation. Sixty-two children (53.2% males) were followed-up for a mean (standard deviation) period of 36.9 (19.7) months. Mean age at transplantation was 10.0 (4.6) years. Twenty-five (40.3%) children had 89 UTI episodes during the study period, equivalent to 0.94 UTI episodes per one patient-year of follow-up. Acute pyelonephritis occurred in 17 (27.4%) children; another 17 (27.4%) had multiple post-KTx UTI. Klebsiella (40.0%) and Escherichia (28.0%) were the commonest organisms. Those with post-KTx UTI were, at transplantation, younger (8.3 vs. 11.2 years; p = 0.017), had lower urinary tract abnormality (LUTA) (13 vs. 1; p = 0.000) and had pre-KTx UTI (13 vs. 5; p = 0.001). Multivariate analysis revealed that only age <5 years at transplantation and LUTA remained significant and that UTI KTx was not associated with worsening graft function. UTI is common after post-KTx. Among our patient cohort, younger age and LUTA were risk factors, but UTI did not affect graft function.

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“…On the other hand, a recent retrospective study from Herthelius et al [33, 34] suggested no increased frequency of UTI after KTX in children with bladder dysfunction. However, the study did not analyze the effect of interventions in the patients with voiding dysfunction.…”

Section: Risk Factorsmentioning

confidence: 98%

Urinary tract infections in children after renal transplantation

John

Kemper

2009

Pediatr Nephrol

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Urinary tract infections (UTI) after pediatric kidney transplantation (KTX) are an important clinical problem and occur in 15-33% of patients. Febrile UTI, whether occurring in the transplanted kidney or the native kidney, should be differentiated from afebrile UTI. The latter may cause significant morbidity and is usually associated with acute graft dysfunction. Risk factors for (febrile) UTI include anatomical, functional, and demographic factors as well as baseline immunosuppression and foreign material, such as catheters and stents. Meticulous surveillance, diagnosis, and treatment of UTI is important to minimize acute morbidity and compromise of long-term graft function. In febrile UTI, parenteral antibiotics are usually indicated, although controlled data are not available. As most data concerning UTI have been accumulated retrospectively, future prospective studies have to be performed to clarify pathogenetic mechanisms and risk factors, improve prophylaxis and treatment, and ultimately optimize long-term renal graft survival.

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Urinary Tract Infections and Bladder Dysfunction After Renal Transplantation in Children

Abstract: Bladder dysfunction did not predispose patients to recurrent urinary tract infections. Graft function declined with time in all patients but the rate of deterioration was faster in the group with recurrent urinary tract infections.

Cited by 39 publications

References 13 publications

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

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

Urinary tract infections in children after renal transplantation

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