Urinary Tract Infection After Kidney Transplantation: Some Centers are Doing Better Than Others

Urinary tract infection (UTI) is the most common infection after kidney transplantation and a source of significant morbidity and cost. The extent to which UTI rates vary across transplant centers remains unclear.

We analyzed kidney transplant recipients with operation dates 3/2017-7/2020 in the National Surgical Quality Improvement Program (NSQIP) Transplant beta phase pilot database. Multivariable logistic regression was used to identify factors associated with 30-day UTI. A hierarchical logistic model was used to assess center outlier status.

A total of 5128 kidney recipients at 25 transplant centers were included. Overall, 30-day UTI incidence was 6.1% (n = 312). Variation existed between centers (range: 0%-12.9%) in unadjusted analyses with five centers identified as outliers. Ureteral stent use (OR 2.33, 95% CI 1.45-3.75, p < 0.01), longer urinary catheter duration (OR 1.03 per day, 95% CI 1.01-1.05, p < 0.01), female gender (OR 2.24, 95% CI 1.76-2.84, p < 0.01) and recipient age (OR 1.01 per year, 95% CI 1.00-1.02, p < 0.01) were all independently associated with higher UTI risk. These variables were found to explain 17% of the variation in UTI rate among centers. After adjustment, three centers were still identified as outliers.

Early UTI incidence varies widely across United States transplant centers. Established risk factors explain some but not all the center variation. Future collaboration and comparison of practices across centers would help to reduce post-transplant complications such as UTIs.