Top

Published in:

01-01-2020 | Pyelonephritis | Topic Paper

UTI in kidney transplant

Authors: Daniel Ness, Jonathon Olsburgh

Published in: World Journal of Urology | Issue 1/2020

Abstract

Urinary tract infection (UTI) remains the most common type of infection contracted by kidney transplant patients. UTI reduces both patient and graft survival. Understanding and managing UTI in transplant patients requires an appreciation of their unique anatomy and physiology. Both the transplant and native urinary systems can be affected by upper and/or lower urinary tract infections. Factors that contribute to UTI in kidney transplant patients are numerous and interact with each other. Factors can include excessive immunosuppression by medications and/or chronic disease, foreign material in the urinary system, transplant kidneys affected by ischaemia–reperfusion injury, non-functioning native kidneys, and abnormal lower urinary tracts. Research is ongoing to highlight the roles each of these contributing factors play and how they may be mitigated to reduce the incidence of UTI. Antimicrobials remain the mainstays of treatment and prophylaxis and this has promoted the development of multi-drug resistant organisms. This challenge necessitates awareness of UTI and methods to reduce rates by all healthcare professionals involved in kidney transplantation.

Lee JR, Bang H, Dadhania D, Hartono C, Aull MJ, Satlin M, August P, Suthanthiran M, Muthukumar T (2013) Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection: a single-center report of 1166 kidney allograft recipients. Transplantation 96(8):732–738. https://doi.org/10.1097/tp.0b013e3182a04997 CrossRefPubMed

Pellé G et al (2007) Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant 7:899–907CrossRef

Zakri R, Srinivasan R, Wong K, Kassimatis T, Asgari E, Olsburgh J (2018) Impact of symptomatic UTI on long-term renal transplant function [abstract]. In: British Transplantation Society Congress 2018; 14–16 March 2018; Brighton Centre, Brighton. O18

Abbott KC, Swanson SJ, Richter ER et al (2004) Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis 44:353–362CrossRef

Britt NS, Hagopian JC, Brennan DC, Pottebaum AA, Santos CAQ, Gharabagi A, Horwedel TA (2017) Effects of recurrent urinary tract infections on graft and patient outcomes after kidney transplantation. Nephrol Dial Transplant 32(10):1758–1766. https://doi.org/10.1093/ndt/gfx237(PubMed PMID: 28967964) CrossRefPubMed

Nicolle LE et al (2005) Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clin Infect Dis 40(5):643–654CrossRef

EAU Guidelines (2018) Edn. presented at the EAU Annual Congress Copenhagen 2018. ISBN 978-94-92671-01-1

Stamm WE (1991) Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 91(Suppl 2):S65–S71CrossRef

Alangaden GJ, Thyagarajan R, Gruber SA et al (2006) Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant 20:401–409CrossRef

10.

de Souza RM, Olsburgh J (2008) Urinary tract infection in the renal transplant patient. Nat Clin Pract Nephrol. 4(5):252–264. https://doi.org/10.1038/ncpneph0781(Epub 2008 Mar 11) CrossRefPubMed

11.

Brennan DC et al (2006) Rabbit antithymocyteglobulin versus basiliximab in renal transplantation. N Engl J Med 355:1967–1977CrossRef

12.

Kamath NS, John GT, Neelakantan N, Kirubakaran MG, Jacob CK (2006) Acute graft pyelonephritis following renal transplantation. Transpl Infect Dis 8:140–147CrossRef

13.

Bonani M, Frey D, de Rougemont O, Mueller NJ, Mueller TF, Graf N, Wüthrich RP (2017) Infections in De Novo kidney transplant recipients treated with the RANKL inhibitor denosumab. Transplantation 101(9):2139–2145. https://doi.org/10.1097/tp.0000000000001547(PubMed PMID: 27798510) CrossRefPubMed

14.

Lentine KL, Axelrod D, Klein C et al (2014) Early clinical complications after ABO-incompatible live-donor kidney transplantation: a national study of Medicare-insured recipients. Transplantation 98(1):54–65CrossRef

15.

Schwab SJ et al (1987) Renal infection in autosomal dominant polycystic kidney disease. Am J Med 82(4):714–718CrossRef

16.

Hatch DA (1994) Kidney transplantation in patients with an abnormal lower urinary tract. Urol Clin North Am 21:311–320PubMed

17.

John U et al (2006) High prevalence of febrile urinary tract infections after paediatric renal transplantation. Nephrol Dial Transpl 21:3269–3274CrossRef

18.

Hessen MT, Kaye D, Zuckerman JM (2000) Infections associated with foreign bodies in the urinary tract. In: Infections associated with indwelling medical devices, 3rd Edn, American Society of Microbiology. pp 325–344CrossRef

19.

Edlich RF, Rodeheaver GT, Thacker JG (1987) Considerations in the choice of sutures for wound closure of the genitourinary tract. J Urol 137(3):373–379 (PubMed PMID: 3546730) CrossRef

20.

Siskind E et al (2013) Removal of foley catheters in live donor kidney transplant recipients on postoperative day 1 does not increase the incidence of urine leaks. Int J Angiol 22(1):45–48CrossRef

21.

Dantas SR, Kuboyama RH, Mazzali M, Moretti ML (2006) Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect 63(2):117–123 (Epub 2006 Mar 3. PubMed PMID: 16517007) CrossRef

22.

de Oliveira LC, Lucon AM, Nahas WC, Ianhez LE, Arap S (2001) Catheter-associated urinary infection in kidney post-transplant patients. Sao Paulo Med J 119:165–168CrossRef

23.

Patel P, Rebollo-Mesa I, Ryan E, Sinha MD, Marks SD, Banga N, Macdougall IC, Webb MC, Koffman G, Olsburgh J (2017) Prophylactic ureteric stents in renal transplant recipients: a multicenter randomized controlled trial of early versus late removal. Am J Transpl 17(8):2129–2138. https://doi.org/10.1111/ajt.14223(Epub 2017 Mar 17. PubMed PMID: 28188678) CrossRef

24.

Cole T, Hakim J, Shapiro R, Kayler LK (2007) Early urethral (Foley) catheter removal positively affects length of stay after renal transplantation. Transplantation. 83(7):995–996 (PubMed PMID: 17460573) CrossRef

25.

Glazer ES, Benedict K, Akhavanheidari M, James S, Molmenti E (2009) Living donor renal transplant recipients tolerate early removal of bladder catheters. Int J Angiol 18(2):67–68CrossRef

26.

Wolters HH, Palmes D, Lordugin E, Bahde R, Senninger N, Hölzen JP, Kebschull L (2014) Antibiotic prophylaxis at urinary catheter removal prevents urinary tract infection after kidney transplantation. Transpl Proc 46(10):3463–3465. https://doi.org/10.1016/j.transproceed.04.019(PubMed PMID: 25498073) CrossRef

27.

Slagt IK, Dor FJ, Tran TC, Kimenai HJ, Weimar W, Ijzermans JN, Terkivatan T (2014) A randomized controlled trial comparing intravesical to extravesical ureteroneocystostomy in living donor kidney transplantation recipients. Kidney Int 85(2):471–477. https://doi.org/10.1038/ki.2013.464(Epub 2013 Nov 27 PubMed PMID: 24284515) CrossRefPubMed

28.

Wilson CH, Rix DA, Manas DM (2013) Routine intraoperative ureteric stenting for kidney transplant recipients. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004925.pub3 CrossRefPubMed

29.

Tavakoli A et al (2007) Impact of stents on urological complications and health care expenditure in renal transplant recipients: results of a prospective, randomized clinical trial. J Urol 177:2260CrossRef

30.

Ali Asgari M, Dadkhah F, Tara SA, Argani H, Tavoosian A, Ghadian A (2016) Early stent removal after kidney transplantation: is it possible? Nephro-Urol Mon 8(2):e30598. https://doi.org/10.5812/numonthly.30598 CrossRef

31.

Dadhkah et al (2016) Benefits and Complications of Removing Ureteral Stent Based on the Elapsed Time After Renal Transplantation Surgery. Nephrourol Mon. 8(2):e31108. https://doi.org/10.5812/numonthly.31108(eCollection) CrossRef

32.

Errando C, Batista JE, Caparros J, Vicente J, Arano P (2000) Urodynamic evaluation and management prior to renal transplantation. Eur Urol 38:415–418CrossRef

33.

Cerilli J, Anderson GW, Evans WE, Smith JP (1976) Renal transplantation in patients with urinary tract abnormalities. Surgery 79(3):248–252 (PubMed PMID: 769210) PubMed

34.

Serrano DP, Flechner SM, Modlin CS, Wyner LM, Novick AC (1996) Transplantation into the long-term defunctionalised bladder. J Urol 156:885–888CrossRef

35.

Salman B, Hassan A, Sultan S, Tophill P, Halawa A (2018) Renal transplant in the abnormal bladder: long-term follow-up. Exp Clin Transpl 16(1):10–15. https://doi.org/10.6002/ect.2016.0193(Epub 2017 Jul 31. PubMed PMID: 28760118) CrossRef

36.

McInerny PD, Picramenos D, Koffman CG, Mundy AR (1995) Is cystoplasty a safe alternative to urinary diversion in patients requiring renal transplantation? Eur Urol 27:117–120CrossRef

37.

González R, Ludwikowski BM (2013) Alternatives to conventional enterocystoplasty in children: a critical review of urodynamic outcomes. Front Pediatr. 1:25. https://doi.org/10.3389/fped.2013.00025(Review. PubMed PMID: 24400271; PubMed Central PMCID: PMC3864223) CrossRefPubMedPubMedCentral

38.

DiBona GF (1987) Renal innervation and denervation: lessons from renal transplantation reconsidered. Artif Organs 11:457–462CrossRef

39.

Willicombe M, Rizzello A, Goodall D, Papalois V, McLean AG, Taube D (2017) Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol. World J Transpl 7(1):34–42CrossRef

40.

Coulthard MG, Keir MJ (2006) Reflux nephropathy in kidney transplants demonstrated by dimercaptosuccinic acid scanning. Transplantation 82:205–210CrossRef

41.

Goya N et al (1997) Prevalence of urinary tract infection during outpatient follow-up after renal transplantation. Infection 25:101–105CrossRef

42.

Cummings LJ, Waters SL, Wattis JA, Graham SJ (2004) The effect of ureteric stents on urine flow: reflux. J Math Biol. 49(1):56–82 (Epub Jan 2. PubMed PMID: 15235819) CrossRef

43.

Margreiter M, Györi GP, Böhmig GA, Trubel S, Mühlbacher F, Steininger R (2013) Value of routine voiding cystourethrography after renal transplantation. Am J Transpl 13(1):130–135. https://doi.org/10.1111/j.1600-6143.2012.04284 CrossRef

44.

Alberts et al (2014) Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis. Transpl Int 27(6):593–605. https://doi.org/10.1111/tri.12301 CrossRefPubMed

45.

Mahmoud KM et al (2001) Impact of schistosomiasis on patient and graft outcome after renal transplantation: 10 years’ follow-up. Nephrol Dial Transpl 16:2214–2221CrossRef

46.

Trofe-Clark J, Sawinski D (2016) BK and other polyomaviruses in kidney transplantation. Semin Nephrol 36(5):372–385. https://doi.org/10.1016/j.semnephrol.2016.05.014 CrossRefPubMed

47.

Wingate JT, Brandenberger J, Weiss A, Scovel LG, Kuhr CS (2017) Ureteral stent duration and the risk of BK polyomavirus viremia or bacteriuria after kidney transplantation. Transpl Infect Dis 19(1):e12644. https://doi.org/10.1111/tid.12644.Epub(PubMed PMID: 27910187) CrossRef

48.

Desouza RM, Prachalias A, Srinivasan P, O’Doherty M, Olsburgh J (2009) Differentiation between infection in kidney and liver cysts in autosomal dominant polycystic kidney disease: use of PET-CT in diagnosis and to guide management. Transpl Proc 41(5):1942–1945CrossRef

49.

Argyrou C, Moris D, Vernadakis S (2017) Tailoring the ‘perfect fit’ for renal transplant recipients with end-stage polycystic kidney disease: indications and timing of native nephrectomy. In Vivo 31(3):307–312 (Review. PubMed PMID: 28438856; PubMed Central PMCID: PMC5461438) CrossRef

50.

Ciszek M et al (2006) Urine cytokines profile in renal transplant patients with asymptomatic bacteriuria. Transplantation 81:1653–1657CrossRef

51.

Muller V, Becker G, Delfs M, Albrecht KH, Philipp T, Heemann U (1998) Do urinary tract infections trigger chronic kidney transplant rejection in man? J Urol 159:1826–1829CrossRef

52.

Origuen J, Lopez-Medrano F, Fernandez-Ruiz M, Polanco N, Gutierrez E, Gonzalez E et al (2016) Should asymptomatic bacteriuria be systematically treated in kidney transplant recipients? Results from a randomized controlled trial. Am J Transpl 16(10):2943–2953 (Medline: 27088545) CrossRef

53.

Coussement J, Scemla A, Abramowicz D, Nagler EV, Webster AC (2018) Antibiotics for asymptomatic bacteriuria in kidney transplant recipients. Cochrane Datab Syst Rev. https://doi.org/10.1002/14651858.cd011357.pub2 CrossRef

54.

Pichler R, Buttazzoni A, Rehder P et al (2011) Endoscopic application of dextranomer/hyaluronic acid copolymer in the treatment of vesico-ureteric reflux after renal transplantation. BJU Int 107:1967–1972CrossRef

55.

Dinckan A, Aliosmanoglu I, Kocak H, Gunseren F, Mesci A, Ertug Z, Yucel S, Suleymanlar G, Gurkan A (2013) Surgical correction of post-transplantation VUR. BJU Int 112:E366–E371. https://doi.org/10.1111/bju.12016 CrossRefPubMed

56.

Sihra N, Goodman A, Zakri R, Sahai A, Malde S (2018) Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol. https://doi.org/10.1038/s41585-018-0106-x([Epub ahead of print] Review. PubMed PMID: 30361493) CrossRefPubMed

57.

Davenport M, Mach KE, Shortliffe LMD, Banaei N, Wang TH, Liao JC (2017) New and developing diagnostic technologies for urinary tract infections. Nat Rev Urol 14(5):296–310CrossRef

58.

Zakri RH, Olsburgh J (2018) Urinary cell-free DNA and UTI; the age of ‘omics’. Nat Rev Urol 25:25. https://doi.org/10.1038/s41585-018-0089-7([Epub ahead of print] PubMed PMID: 30218037) CrossRef

59.

Huttner A et al (2017) Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial. Lancet Infect Dis 17:528–537CrossRef

60.

Jason Akerman et al (2018) PD25-10 comparison of cystoscopic versus magnetic retrieval device for removal of ureteral stents in renal transplant patients: a randomized pilot study. J Urol 199(4):e550

Title: UTI in kidney transplant
Authors: Daniel Ness
Jonathon Olsburgh
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Pyelonephritis
Urinary Tract Infection
Pyelonephritis
Published in: World Journal of Urology / Issue 1/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02742-6

At a glance: The STEP trials

Springer Medicine

UTI in kidney transplant

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2020

Tumor characteristics, oncological and functional outcomes after radical prostatectomy in very young men ≤ 45 years of age

Mind the gap: management of benign prostatic obstruction (BPO) surgical candidates on antithrombotics

A phase 3, open-label, multicenter study of a 6-month pre-mixed depot formulation of leuprolide mesylate in advanced prostate cancer patients

Association of super-extended lymphadenectomy at radical cystectomy with perioperative complications and re-hospitalization

Patients knowledge and experience with urinary and peripheral intravenous catheters

Challenges in urogenital tuberculosis