A five-year retrospective study focused on urinary tract infections in kidney transplant recipients in the current era of immunosuppression

Abstract

After kidney transplantation, UTI are the most common infection concern and can cause acute renal injury (AKI) in allografts. However, long-term allograft function, loss, and mortality risk are inconsistent. A retrospective cohort research of 1,341 kidney transplant recipients (KTR) from January 2014 to March 2019 assessed UTI incidence, risk factors, and consequences on AKI and allograft function in the first year. All first-year post-transplant UTI patients were recorded. Third-generation cephalosporin (1 gr, two doses) and 500 mg intravesical amikacin were given to all patients 1 day before surgery. After that, patients had TMP-SMX (160/800 mg qd) for 3-4 months to prevent Pneumocystis jirovecii pneumonia, and the main immunosuppressive regimen was mycophenolate mofetil, prednisone and a Calcineurin inhibitors. The UTI incidence was 42.5%. Escherichia coli was the most common causal bacteria, accounting for a significant amount of strains of Extended-spectrum beta-lactamase (ESBL) and AKI occurred more in the first and second UTI. Our analysis showed risk factors of anti-thymocyte globulin (ATG) use (RR 1.52; p = 0.032), double J catheter (RR 1.9; p = 0.004), and urinary tract abnormalities (RR 1.92; p = 0.007). Although UTI was common and associated with AKI, it did not affect allograft function at 12 months post-transplantation.

Keywords: acute kidney injury (AKI); immunosupresion; kidney function; kidney tranplantation; urinary tract infection (UTI).