Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Sep-Oct;24(5):636-42.
doi: 10.1111/j.1399-0012.2009.01129.x.

Lower risk of urinary tract infection with low-dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid-withdrawal immunosuppression regimen

Jeffrey Allen Giullian  1 , Kerri Cavanaugh, Heidi Schaefer
Affiliations
Comparative Study

Lower risk of urinary tract infection with low-dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid-withdrawal immunosuppression regimen

Jeffrey Allen Giullian et al. Clin Transplant. 2010 Sep-Oct.

Abstract

Background: Urinary tract infections (UTI) are common in renal transplant recipients. Trimethoprim/sulfamethoxazole (TMP/SMZ) in moderate to high daily doses prevents Pneumocystis jiroveci (PCP) and reduces the risk of UTI in renal transplant patients. Low-dose TMP/SMZ also reduces the risk of PCP, although its ability to reduce the risk of UTI is uncertain.

Design: Retrospective review of 158 patients who received a renal transplant without corticosteroids for maintenance immunosuppression.

Results: Forty percent of patients initially prescribed TMP/SMZ ultimately stopped this medication early because of an adverse reaction. Urinary infection occurred in 16% without a significant difference in the risk of UTI between those treated with dapsone vs. those treated with TMP/SMZ (HR [95%CI]: 1.7 [0.75, 3.9], p = 0.2). In the subset of patients who were older than age 47 yr (mean age for this cohort, SD ± 6.2 yr), those treated with dapsone originally or who switched from TMP/SMZ to dapsone had a greater risk of UTI compared to patients who remained on TMP/SMZ (HR [95%CI]: 4.3 [1.2, 15.5], p = 0.024).

Conclusions: For renal transplant recipients over the age of 47 yr, treated without long-term glucocorticoids, our retrospective data suggest that low-dose TMP/SMZ is associated with a lower risk of UTI compared to dapsone prophylaxis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Survival analysis of time to first UTI
Figure 2
Figure 2
Survival analysis of time to first UTI, older age
See this image and copyright information in PMC

References

    1. Tolkhoff-Rubin NE, Rubin RH. Urinary tract infection in the immunocompromised host: lessons from kidney transplantation and the AIDS epidemic. Infect Dis Clin North Am. 1997;11:707–17. - PubMed
    1. Alangaden GH, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, West MS, Sillix DH, Chandrasekar PH, Haririan A. Infections complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006;20:401–409. - PubMed
    1. Valera B, Gentil MA, Cabello V, Fijo J, Cordero E, Cisneros JM. Epidemiology of Urinary Infections in Renal Transplant Recipients. Transplantation Proceedings. 2006;38:2414–2415. - PubMed
    1. Wilson CH, Bhatti AA, Rix DA, Manas DM, for the Cochrane Database Systematic Review Routine intraoperative ureteric stenting for kidney transplant recipients. 2005;4 - PubMed
    1. Glazier DB, Jacobs MG, Lyman NW, Whang MI, Manor E, Mulgaonkar SP. Urinary tract infection associated with ureteral stents in renal transplantation. Can J Urol. 1998;5(1):462–466. - PubMed

Publication types

MeSH terms

Substances