THE PROBLEM OF URINARY TRACT INFECTIONS POST KIDNEY TRANSPLANTATION

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.


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