N TIEKINK 1, S JAHAN 1, J ERN 1, C TAN 1, R FAULL 1
1CNARTS, Adelaide, Australia
Aim: To investigate the effect of change in immunosuppression protocol on the pattern of urinary tract infections following renal transplantation.
Background: Urinary tract infection (UTI) post kidney transplantation is a common problem, with a reported incidence rate of between 10 to 98% in the literature. Recurrent UTIs are associated with increased morbidity, rates of hospitalisation, and the development of multidrug-resistant organisms. Kidney transplant recipients (KTR) are often maintained on Trimethoprim/ Sulfamethoxazole prophylaxis against pneumocystis carinii, but despite this, UTIs continue to be common with risk of resistance to this antibiotic.
In mid-2018 Central Northern Adelaide Renal and Transplantation Service (CNARTS) changed routine induction immunosuppression for kidney transplant recipients from Basiliximab to antithymocyte globulin (ATG).
Methods: Single centre 4-year retrospective analysis of all patients receiving kidney transplantation from Jan 2017 to Dec 2020. Pathology results, patient electronic records, and transplantation meeting slides were reviewed.
Results: Between 2017 and 2020, 108 out of 251 (43%) KTR developed at least one UTI, with almost two-thirds of patients having more than one episode. Out of 108 KTRs with UTI, 68 were treated with ATG and 40 with Basiliximab; resulting in KTRs receiving ATG as induction immunosuppression nearly twice as likely to develop a UTI compared to those treated with Basiliximab. Diabetes was an independent risk factor for developing a UTI whilst age was not associated with an increased risk of development of UTI.
Conclusions: UTIs are a common infectious complication following renal transplantation. Their frequency further increased following the transition from Basiliximab to ATG as induction immunosuppression.
Sadia is a nephrology trainee from the Royal Adelaide Hospital with an evolving enthusiasm for all things transplant.