Presentation Authors: Rhana Zakri*, Theo Kassimatis, Pinky kotecha, Rohit Srinivasan, Elham Asgari, Jonathon Olsburgh, London, United Kingdom
Introduction: Urinary tract infection (UTI) affects 25-40% of renal transplant (RTx) recipients in the first year. UTI, particularly pyelonephritis, can cause rejection, sepsis, impaired RTx function, allograft loss and death. We investigated the incidence of UTIs (lower versus upper tract) and effect on allograft function.
Methods: Retrospective analysis of RTx patients was performed between 2010-2012. Adult patients with follow-up at our institution only were included. Those with primary non-function or graft nephrectomy < 1 month post transplant were excluded. Follow-up was for 5 years for number of UTIs and eGFR. Primary outcome measure was change in graft function and secondarily, graft survival. Strict definitions for cystitis, pyelonephritis and asymptomatic bacteriuria (ABU) were followed.
Results: N=610 RTx took place and n=213 were followed up at our institution. n=206 patients were included for analysis after exclusions. Mean recipient age was 47.3yrs. 62.6% were male. E-Coli had the highest incidence 1 year post RTx. In 206 patients over 5 years, n=447 had positive urine cultures, 43% had >1 UTI. 85% had their 1st UTI in the < 2yrs post RTx. The incidence of ABU, cystitis & pyelonephritis was 14%, 12%, 17% respectively. 5.3% had recurrent pyelonephritis and 6.8% had recurrent cystitis. Over 5yrs, pts with no UTI had a mean change in eGFR of 8.1ml/min compared to a statistically significant difference of 20.0ml/min in patients with a symptomatic UTI. There was no statistically significant difference in graft survival at 5 years between those with UTIs and those without. There was no difference in further UTI episodes in the next 5 years if ABUs were treated or not. There was a higher incidence of recurrent UTIs in ABUs that were not treated, but with no statistical significance. Between 2010 and 2017 the mean number of UTI episodes was 3.7. There was a statistically significant change in eGFR over 5 years in patients with >5 UTIs.
Conclusions: Long term graft dysfunction occurs in patients with upper tract UTI (pyelonephritis) as a result of renal scarring but have we underestimated the effect of cystitis and the â€˜number of hitsâ€™ on graft dysfunction?