UTI in Renal Transplantation

36

Indian Journal of Transplantation

UTI in Renal Transplantation A. Chandra Shekar, Srinivas Nalloor, S. Ramakrishnan, Dilip Rangarajan NU Trust, Bangalore

Indian J Transplant 2009; 3: 26-40

Ureteric stenting

11 (16.67%)

Associated co-morbidities ADPKD

1 (1.5%)

Diabetes mellitus

7 (10.6%)

Urologic interventions

Aim All patients who underwent living related donor renal transplantation at N.U. Hospitals, Bangalore from 2001 till date were retrospectively analyzed for the occurrence of UTI. The clinical presentation, management and outcome were assessed. Results 66 (60.55%) out of 109 consecutive live-related renal transplant recipients had UTI. Male 47 Females 19 Mean recipient age 36.71years (range 17 to 62) Mean donor age 42.12 years (range 18 to 60) Immunosuppression Induction 5 (7%) Tacrolimus based 6 (9%) CsA based 58 (87%) AZA based 59 (89%) MMF based 6 (9%) Change in immunosuppression AZA to MMF 28 patients Acute rejection Treatment of acute rejection IV methyl Prednisolone 25 (92.6%) OKT 3 1 (3.7%) UTI presentation Graft pyelonephritis 6 (9.1%) LUTS 60 (90.9%) Recurrent UTI 4 (6.1%) Cortical renal abscess 2 (3%) Urosepsis 2 (3%) UTI occurred most often 6 months following renal transplantation Common organisms E.coli, Klebsiella, Enterococcus Fecalis Predisposing factors VUR, reflux nephropathy

6 (9.1%)

Bladder outlet obstruction

5 (7.56%)

Copyright © 2009 by The Indian Society of Organ Transplantation

Urethral dilatation

2 (3%)

Nephrectomy (Graft)

2 (3%)

Bladder neck incision

2 (3%)

UTI prophylaxis Renal allograft dysfunction observed during UTI episodes most often. OUTCOME Death

18 (27.27%)

Cause of death Sepsis

10 (55.56%)

Renal failure

2 (11.11 %)

IHD

1 (5.56%)

CVA

1 (5.56%)

Unknown

4 (22.22%)

Conclusions 1. UTI was the commonest infection among renal transplant recipients in our study accounting for 60.55% of infections complications. 2. Ureteric stenting, vesicoureteric reflux, bladder outlet obstruction and immunosuppression were important predisposing factors. 3. The most commonly implicated organisms were the Gram negative bacilli (E.coli, Klebsiella) and Enterococcus. 4. UTI occurred more frequently 6 months posttransplant and most episodes were associated with renal allograft dysfunction.