Urinary Tract Infections in Kidney Transplant Recipients: A Narrative Review.

Area of Science:

• Nephrology
• Transplantation Immunology
• Infectious Diseases

Background:

• Urinary tract infections (UTIs) are the most common complication post-kidney transplant, impacting graft function and survival.
• Chronic kidney disease (CKD) and rising antimicrobial resistance exacerbate UTI challenges in transplant recipients.
• Understanding UTI pathophysiology is crucial for effective management in this vulnerable population.

Purpose of the Study:

• To review classification, pathophysiology, risk factors, and management strategies for UTIs in kidney transplant recipients.
• To emphasize antimicrobial stewardship and explore non-antibiotic adjuncts for UTI prevention and treatment.
• To provide evidence-based guidance for optimizing UTI care in kidney transplant patients.

Main Methods:

• Focused narrative review of existing literature on UTIs in kidney transplant recipients.
• Analysis of risk factors including immunosuppression, urological devices, and urodynamic abnormalities.
• Evaluation of evidence for antibiotic and non-antibiotic preventive and therapeutic interventions.

Main Results:

• UTI risk is highest early post-transplant, influenced by immunosuppression, devices, and graft injury.
• Asymptomatic bacteriuria treatment is not recommended; symptomatic UTIs require prompt, de-escalated therapy.
• Preventive measures include hydration, cranberry, methenamine hippurate, and vaginal estrogen; D-mannose/probiotics show inconsistent evidence.
• Uromodulin and SGLT2 inhibitors are emerging factors in UTI defense and management.

Conclusions:

• An integrated, multimodal approach is essential for managing UTIs post-kidney transplant.
• Combining antibiotic stewardship with non-antibiotic interventions can reduce recurrences and resistance.
• Optimizing UTI management is key to preserving long-term allograft longevity and recipient health.