Related Experiment Videos
High incidence of bacteriuria following renal transplantation in children
M Sharifian1, L Rees, R S Trompeter
1Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
Bacteriuria (bacteria in urine) is common after pediatric kidney transplants, especially in those with prior urinary issues. While often asymptomatic, it causes temporary kidney function decline but doesn't impact long-term graft survival.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Infectious Diseases in Transplant
Background:
- Bacteriuria is a frequent complication following kidney transplantation in children.
- Limited data exists on pediatric bacteriuria incidence, causes, and long-term graft impact.
- This study addresses the knowledge gap in pediatric post-transplant urinary tract infections.
Purpose of the Study:
- To determine the incidence of bacteriuria in pediatric kidney transplant recipients.
- To identify predisposing factors for post-transplant bacteriuria in children.
- To evaluate the short-term and long-term effects of bacteriuria on kidney graft function.
Main Methods:
- Retrospective analysis of 168 kidney transplants in 142 children (1987-1994).
- Data collected on patient demographics, transplant details, and bacteriuria episodes.
- Correlation of bacteriuria with pre-transplant history, bladder pathology, and graft function markers (plasma creatinine, GFR).
Main Results:
- 46% of patients experienced bacteriuria (1 episode/23 patient-months), most within the first year.
- Recurrences were noted in 28% of affected children.
- Bacteriuria was strongly associated with prior bacteriuria history and bladder pathology, but not with sex, reflux, donor type, or rejection.
- A transient rise in plasma creatinine occurred with bacteriuria, even when asymptomatic.
- No significant long-term decrease in glomerular filtration rate was observed.
Conclusions:
- Bacteriuria is a common occurrence in pediatric kidney transplant recipients.
- A history of bacteriuria and existing bladder pathology are key risk factors.
- While causing transient renal function impairment, bacteriuria does not appear to compromise long-term graft survival in this cohort.
Background:
Bacteriuria is common post-transplant. However, most studies are in adults with a short follow-up. We have assessed the incidence of bacteriuria, predisposing causes and its effect on short and long-term graft function in children.
Methods:
The notes of 142 children (67% male) who received 168 kidney transplants (138 cadaveric) between 1987 and 1994 were studied. The mean age at transplantation was 9.0 +/- 4.5 years, and 32 children were transplanted pre-emptively. Diagnoses reflected those found in any children's renal failure programme.
Results:
Two hundred and thirty one episodes of bacteriuria were detected in 66 patients patients (46%): a rate of one episode per 23 patient months of follow-up. Fifty two percent were during the first year, and 29% of these during the first 4 weeks post-transplant. Forty two children (28%) had recurrences. The incidence was not affected by sex, vesico-ureteric reflux into native kidneys, donor source, circumcision in boys, dialysis pre-transplant or acute rejection. Bacteriuria was significantly more common in patients with a history of bacteriuria before transplant (P < 0.005) and with bladder pathology (P < 0.001). Organisms were predominantly coliforms (41%); 70% were Gram-negative. Sixty percent were resistant to the prescribed antibiotic prophylaxis. There was an associated transient rise in plasma creatinine concentration: mean pre-episode 111 +/- 86 mumol/l vs mean post-episode 134 +/- 108 mumol/l (P < 0.0001). Seventy two percent of episodes were asymptomatic, but even in this group 81% had an associated rise in plasma creatinine (P < 0.001). Despite this, there was no significant decrease in glomerular filtration rate in patients with bacteriuria compared with patients without at the end of follow-up: 50 vs 56 ml/min/1.73 m2 respectively.
Conclusion:
Bacteriuria is common post-transplant, occurring most often in those with bladder pathology or with a history of bacteriuria pre-transplant.