Five compelling UTI questions after kidney transplant

Area of Science:

• Nephrology
• Infectious Diseases
• Transplantation Immunology

Background:

• Urinary tract infection (UTI) is a leading infectious complication in kidney transplant recipients (KTR).
• Post-transplant infections significantly contribute to morbidity, mortality, graft dysfunction, and rejection.
• Understanding UTI in KTX is crucial for improving patient and graft outcomes.

Purpose of the Study:

• To review key clinical questions concerning urinary tract infections (UTIs) in kidney transplantation (KTX).
• To identify and address significant challenges related to UTI management in KTR.

Main Methods:

• A meeting of kidney transplant (KT) program physicians was convened to identify relevant clinical questions.
• Five clinically relevant questions regarding UTI after KTX were selected based on physician consensus and generalizability.

Main Results:

• Approximately 50% of KTR develop UTI within the first three months post-transplant.
• Common uropathogens include Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis.
• Identified risk factors include female sex, advanced age, prior UTI, prolonged catheterization, delayed graft function, and cadaveric kidney transplant.

Conclusions:

• The incidence of post-transplant UTI is comparable globally.
• Escherichia coli remains the predominant pathogen.
• Cadaveric donor and post-dialysis transplantation are independent risk factors for UTI; further research is needed on long-term outcomes.