Urinary tract infections in pediatric renal transplant recipients--a two center risk factors study

Area of Science:

• Pediatric Nephrology
• Transplantation Immunology
• Infectious Diseases

Background:

• Urinary tract infections (UTI) are a frequent complication in pediatric renal transplant recipients.
• UTI can significantly impair graft function and patient outcomes.
• Understanding UTI prevalence and risk factors is crucial for optimizing care in this vulnerable population.

Purpose of the Study:

• To determine the prevalence of UTI in children following kidney transplantation.
• To identify significant risk factors associated with UTI development post-transplant.
• To evaluate the impact of UTI on graft function in pediatric renal transplant recipients.

Main Methods:

• Retrospective cross-sectional study involving 76 pediatric renal transplant patients.
• Data collected included patient demographics, transplant details, and UTI occurrence.
• Statistical analysis was performed to identify risk factors and assess outcomes.

Main Results:

• A total of 28% of patients (21/76) experienced at least one UTI post-transplant, with the first UTI occurring at a median of 160 days.
• Significant risk factors for UTI included obstructive uropathy (RR=2.6), history of pyelonephritis (PN) pre-transplant (RR=2.7), and pre-transplant vesicoureteral reflux (VUR) (RR=2.2).
• These factors also reduced infection-free survival time. Most UTI led to reversible acute graft dysfunction, but long-term function assessment using serum creatinine (SCr) was unreliable.

Conclusions:

• UTI is a significant concern in pediatric kidney transplant recipients, occurring in 28% of cases, predominantly within the first year despite prophylaxis.
• Obstructive uropathy, pre-transplant UTI history, and VUR are identified as critical risk factors.
• While UTI can cause acute graft dysfunction, its long-term impact on graft function requires further investigation.