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UTI in kidney transplant

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Abstract

Urinary tract infection (UTI) remains the most common type of infection contracted by kidney transplant patients. UTI reduces both patient and graft survival. Understanding and managing UTI in transplant patients requires an appreciation of their unique anatomy and physiology. Both the transplant and native urinary systems can be affected by upper and/or lower urinary tract infections. Factors that contribute to UTI in kidney transplant patients are numerous and interact with each other. Factors can include excessive immunosuppression by medications and/or chronic disease, foreign material in the urinary system, transplant kidneys affected by ischaemia–reperfusion injury, non-functioning native kidneys, and abnormal lower urinary tracts. Research is ongoing to highlight the roles each of these contributing factors play and how they may be mitigated to reduce the incidence of UTI. Antimicrobials remain the mainstays of treatment and prophylaxis and this has promoted the development of multi-drug resistant organisms. This challenge necessitates awareness of UTI and methods to reduce rates by all healthcare professionals involved in kidney transplantation.

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References

  1. Lee JR, Bang H, Dadhania D, Hartono C, Aull MJ, Satlin M, August P, Suthanthiran M, Muthukumar T (2013) Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection: a single-center report of 1166 kidney allograft recipients. Transplantation 96(8):732–738. https://doi.org/10.1097/tp.0b013e3182a04997

    Article  CAS  PubMed  Google Scholar 

  2. Pellé G et al (2007) Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant 7:899–907

    Article  Google Scholar 

  3. Zakri R, Srinivasan R, Wong K, Kassimatis T, Asgari E, Olsburgh J (2018) Impact of symptomatic UTI on long-term renal transplant function [abstract]. In: British Transplantation Society Congress 2018; 14–16 March 2018; Brighton Centre, Brighton. O18

  4. Abbott KC, Swanson SJ, Richter ER et al (2004) Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis 44:353–362

    Article  Google Scholar 

  5. Britt NS, Hagopian JC, Brennan DC, Pottebaum AA, Santos CAQ, Gharabagi A, Horwedel TA (2017) Effects of recurrent urinary tract infections on graft and patient outcomes after kidney transplantation. Nephrol Dial Transplant 32(10):1758–1766. https://doi.org/10.1093/ndt/gfx237(PubMed PMID: 28967964)

    Article  CAS  PubMed  Google Scholar 

  6. Nicolle LE et al (2005) Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clin Infect Dis 40(5):643–654

    Article  Google Scholar 

  7. EAU Guidelines (2018) Edn. presented at the EAU Annual Congress Copenhagen 2018. ISBN 978-94-92671-01-1

  8. Stamm WE (1991) Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 91(Suppl 2):S65–S71

    Article  Google Scholar 

  9. Alangaden GJ, Thyagarajan R, Gruber SA et al (2006) Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant 20:401–409

    Article  Google Scholar 

  10. de Souza RM, Olsburgh J (2008) Urinary tract infection in the renal transplant patient. Nat Clin Pract Nephrol. 4(5):252–264. https://doi.org/10.1038/ncpneph0781(Epub 2008 Mar 11)

    Article  PubMed  Google Scholar 

  11. Brennan DC et al (2006) Rabbit antithymocyteglobulin versus basiliximab in renal transplantation. N Engl J Med 355:1967–1977

    Article  CAS  Google Scholar 

  12. Kamath NS, John GT, Neelakantan N, Kirubakaran MG, Jacob CK (2006) Acute graft pyelonephritis following renal transplantation. Transpl Infect Dis 8:140–147

    Article  CAS  Google Scholar 

  13. Bonani M, Frey D, de Rougemont O, Mueller NJ, Mueller TF, Graf N, Wüthrich RP (2017) Infections in De Novo kidney transplant recipients treated with the RANKL inhibitor denosumab. Transplantation 101(9):2139–2145. https://doi.org/10.1097/tp.0000000000001547(PubMed PMID: 27798510)

    Article  CAS  PubMed  Google Scholar 

  14. Lentine KL, Axelrod D, Klein C et al (2014) Early clinical complications after ABO-incompatible live-donor kidney transplantation: a national study of Medicare-insured recipients. Transplantation 98(1):54–65

    Article  Google Scholar 

  15. Schwab SJ et al (1987) Renal infection in autosomal dominant polycystic kidney disease. Am J Med 82(4):714–718

    Article  CAS  Google Scholar 

  16. Hatch DA (1994) Kidney transplantation in patients with an abnormal lower urinary tract. Urol Clin North Am 21:311–320

    CAS  PubMed  Google Scholar 

  17. John U et al (2006) High prevalence of febrile urinary tract infections after paediatric renal transplantation. Nephrol Dial Transpl 21:3269–3274

    Article  Google Scholar 

  18. Hessen MT, Kaye D, Zuckerman JM (2000) Infections associated with foreign bodies in the urinary tract. In: Infections associated with indwelling medical devices, 3rd Edn, American Society of Microbiology. pp 325–344

    Chapter  Google Scholar 

  19. Edlich RF, Rodeheaver GT, Thacker JG (1987) Considerations in the choice of sutures for wound closure of the genitourinary tract. J Urol 137(3):373–379 (PubMed PMID: 3546730)

    Article  CAS  Google Scholar 

  20. Siskind E et al (2013) Removal of foley catheters in live donor kidney transplant recipients on postoperative day 1 does not increase the incidence of urine leaks. Int J Angiol 22(1):45–48

    Article  Google Scholar 

  21. Dantas SR, Kuboyama RH, Mazzali M, Moretti ML (2006) Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect 63(2):117–123 (Epub 2006 Mar 3. PubMed PMID: 16517007)

    Article  CAS  Google Scholar 

  22. de Oliveira LC, Lucon AM, Nahas WC, Ianhez LE, Arap S (2001) Catheter-associated urinary infection in kidney post-transplant patients. Sao Paulo Med J 119:165–168

    Article  Google Scholar 

  23. Patel P, Rebollo-Mesa I, Ryan E, Sinha MD, Marks SD, Banga N, Macdougall IC, Webb MC, Koffman G, Olsburgh J (2017) Prophylactic ureteric stents in renal transplant recipients: a multicenter randomized controlled trial of early versus late removal. Am J Transpl 17(8):2129–2138. https://doi.org/10.1111/ajt.14223(Epub 2017 Mar 17. PubMed PMID: 28188678)

    Article  CAS  Google Scholar 

  24. Cole T, Hakim J, Shapiro R, Kayler LK (2007) Early urethral (Foley) catheter removal positively affects length of stay after renal transplantation. Transplantation. 83(7):995–996 (PubMed PMID: 17460573)

    Article  CAS  Google Scholar 

  25. Glazer ES, Benedict K, Akhavanheidari M, James S, Molmenti E (2009) Living donor renal transplant recipients tolerate early removal of bladder catheters. Int J Angiol 18(2):67–68

    Article  Google Scholar 

  26. Wolters HH, Palmes D, Lordugin E, Bahde R, Senninger N, Hölzen JP, Kebschull L (2014) Antibiotic prophylaxis at urinary catheter removal prevents urinary tract infection after kidney transplantation. Transpl Proc 46(10):3463–3465. https://doi.org/10.1016/j.transproceed.04.019(PubMed PMID: 25498073)

    Article  CAS  Google Scholar 

  27. Slagt IK, Dor FJ, Tran TC, Kimenai HJ, Weimar W, Ijzermans JN, Terkivatan T (2014) A randomized controlled trial comparing intravesical to extravesical ureteroneocystostomy in living donor kidney transplantation recipients. Kidney Int 85(2):471–477. https://doi.org/10.1038/ki.2013.464(Epub 2013 Nov 27 PubMed PMID: 24284515)

    Article  PubMed  Google Scholar 

  28. Wilson CH, Rix DA, Manas DM (2013) Routine intraoperative ureteric stenting for kidney transplant recipients. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004925.pub3

    Article  PubMed  Google Scholar 

  29. Tavakoli A et al (2007) Impact of stents on urological complications and health care expenditure in renal transplant recipients: results of a prospective, randomized clinical trial. J Urol 177:2260

    Article  CAS  Google Scholar 

  30. Ali Asgari M, Dadkhah F, Tara SA, Argani H, Tavoosian A, Ghadian A (2016) Early stent removal after kidney transplantation: is it possible? Nephro-Urol Mon 8(2):e30598. https://doi.org/10.5812/numonthly.30598

    Article  Google Scholar 

  31. Dadhkah et al (2016) Benefits and Complications of Removing Ureteral Stent Based on the Elapsed Time After Renal Transplantation Surgery. Nephrourol Mon. 8(2):e31108. https://doi.org/10.5812/numonthly.31108(eCollection)

    Article  Google Scholar 

  32. Errando C, Batista JE, Caparros J, Vicente J, Arano P (2000) Urodynamic evaluation and management prior to renal transplantation. Eur Urol 38:415–418

    Article  CAS  Google Scholar 

  33. Cerilli J, Anderson GW, Evans WE, Smith JP (1976) Renal transplantation in patients with urinary tract abnormalities. Surgery 79(3):248–252 (PubMed PMID: 769210)

    CAS  PubMed  Google Scholar 

  34. Serrano DP, Flechner SM, Modlin CS, Wyner LM, Novick AC (1996) Transplantation into the long-term defunctionalised bladder. J Urol 156:885–888

    Article  CAS  Google Scholar 

  35. Salman B, Hassan A, Sultan S, Tophill P, Halawa A (2018) Renal transplant in the abnormal bladder: long-term follow-up. Exp Clin Transpl 16(1):10–15. https://doi.org/10.6002/ect.2016.0193(Epub 2017 Jul 31. PubMed PMID: 28760118)

    Article  Google Scholar 

  36. McInerny PD, Picramenos D, Koffman CG, Mundy AR (1995) Is cystoplasty a safe alternative to urinary diversion in patients requiring renal transplantation? Eur Urol 27:117–120

    Article  Google Scholar 

  37. González R, Ludwikowski BM (2013) Alternatives to conventional enterocystoplasty in children: a critical review of urodynamic outcomes. Front Pediatr. 1:25. https://doi.org/10.3389/fped.2013.00025(Review. PubMed PMID: 24400271; PubMed Central PMCID: PMC3864223)

    Article  PubMed  PubMed Central  Google Scholar 

  38. DiBona GF (1987) Renal innervation and denervation: lessons from renal transplantation reconsidered. Artif Organs 11:457–462

    Article  CAS  Google Scholar 

  39. Willicombe M, Rizzello A, Goodall D, Papalois V, McLean AG, Taube D (2017) Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol. World J Transpl 7(1):34–42

    Article  Google Scholar 

  40. Coulthard MG, Keir MJ (2006) Reflux nephropathy in kidney transplants demonstrated by dimercaptosuccinic acid scanning. Transplantation 82:205–210

    Article  CAS  Google Scholar 

  41. Goya N et al (1997) Prevalence of urinary tract infection during outpatient follow-up after renal transplantation. Infection 25:101–105

    Article  CAS  Google Scholar 

  42. Cummings LJ, Waters SL, Wattis JA, Graham SJ (2004) The effect of ureteric stents on urine flow: reflux. J Math Biol. 49(1):56–82 (Epub Jan 2. PubMed PMID: 15235819)

    Article  CAS  Google Scholar 

  43. Margreiter M, Györi GP, Böhmig GA, Trubel S, Mühlbacher F, Steininger R (2013) Value of routine voiding cystourethrography after renal transplantation. Am J Transpl 13(1):130–135. https://doi.org/10.1111/j.1600-6143.2012.04284

    Article  CAS  Google Scholar 

  44. Alberts et al (2014) Ureterovesical anastomotic techniques for kidney transplantation: a systematic review and meta-analysis. Transpl Int 27(6):593–605. https://doi.org/10.1111/tri.12301

    Article  PubMed  Google Scholar 

  45. Mahmoud KM et al (2001) Impact of schistosomiasis on patient and graft outcome after renal transplantation: 10 years’ follow-up. Nephrol Dial Transpl 16:2214–2221

    Article  CAS  Google Scholar 

  46. Trofe-Clark J, Sawinski D (2016) BK and other polyomaviruses in kidney transplantation. Semin Nephrol 36(5):372–385. https://doi.org/10.1016/j.semnephrol.2016.05.014

    Article  CAS  PubMed  Google Scholar 

  47. Wingate JT, Brandenberger J, Weiss A, Scovel LG, Kuhr CS (2017) Ureteral stent duration and the risk of BK polyomavirus viremia or bacteriuria after kidney transplantation. Transpl Infect Dis 19(1):e12644. https://doi.org/10.1111/tid.12644.Epub(PubMed PMID: 27910187)

    Article  Google Scholar 

  48. Desouza RM, Prachalias A, Srinivasan P, O’Doherty M, Olsburgh J (2009) Differentiation between infection in kidney and liver cysts in autosomal dominant polycystic kidney disease: use of PET-CT in diagnosis and to guide management. Transpl Proc 41(5):1942–1945

    Article  CAS  Google Scholar 

  49. Argyrou C, Moris D, Vernadakis S (2017) Tailoring the ‘perfect fit’ for renal transplant recipients with end-stage polycystic kidney disease: indications and timing of native nephrectomy. In Vivo 31(3):307–312 (Review. PubMed PMID: 28438856; PubMed Central PMCID: PMC5461438)

    Article  Google Scholar 

  50. Ciszek M et al (2006) Urine cytokines profile in renal transplant patients with asymptomatic bacteriuria. Transplantation 81:1653–1657

    Article  CAS  Google Scholar 

  51. Muller V, Becker G, Delfs M, Albrecht KH, Philipp T, Heemann U (1998) Do urinary tract infections trigger chronic kidney transplant rejection in man? J Urol 159:1826–1829

    Article  CAS  Google Scholar 

  52. Origuen J, Lopez-Medrano F, Fernandez-Ruiz M, Polanco N, Gutierrez E, Gonzalez E et al (2016) Should asymptomatic bacteriuria be systematically treated in kidney transplant recipients? Results from a randomized controlled trial. Am J Transpl 16(10):2943–2953 (Medline: 27088545)

    Article  CAS  Google Scholar 

  53. Coussement J, Scemla A, Abramowicz D, Nagler EV, Webster AC (2018) Antibiotics for asymptomatic bacteriuria in kidney transplant recipients. Cochrane Datab Syst Rev. https://doi.org/10.1002/14651858.cd011357.pub2

    Article  Google Scholar 

  54. Pichler R, Buttazzoni A, Rehder P et al (2011) Endoscopic application of dextranomer/hyaluronic acid copolymer in the treatment of vesico-ureteric reflux after renal transplantation. BJU Int 107:1967–1972

    Article  Google Scholar 

  55. Dinckan A, Aliosmanoglu I, Kocak H, Gunseren F, Mesci A, Ertug Z, Yucel S, Suleymanlar G, Gurkan A (2013) Surgical correction of post-transplantation VUR. BJU Int 112:E366–E371. https://doi.org/10.1111/bju.12016

    Article  PubMed  Google Scholar 

  56. Sihra N, Goodman A, Zakri R, Sahai A, Malde S (2018) Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol. https://doi.org/10.1038/s41585-018-0106-x([Epub ahead of print] Review. PubMed PMID: 30361493)

    Article  PubMed  Google Scholar 

  57. Davenport M, Mach KE, Shortliffe LMD, Banaei N, Wang TH, Liao JC (2017) New and developing diagnostic technologies for urinary tract infections. Nat Rev Urol 14(5):296–310

    Article  Google Scholar 

  58. Zakri RH, Olsburgh J (2018) Urinary cell-free DNA and UTI; the age of ‘omics’. Nat Rev Urol 25:25. https://doi.org/10.1038/s41585-018-0089-7([Epub ahead of print] PubMed PMID: 30218037)

    Article  Google Scholar 

  59. Huttner A et al (2017) Safety, immunogenicity, and preliminary clinical efficacy of a vaccine against extraintestinal pathogenic Escherichia coli in women with a history of recurrent urinary tract infection: a randomised, single-blind, placebo-controlled phase 1b trial. Lancet Infect Dis 17:528–537

    Article  CAS  Google Scholar 

  60. Jason Akerman et al (2018) PD25-10 comparison of cystoscopic versus magnetic retrieval device for removal of ureteral stents in renal transplant patients: a randomized pilot study. J Urol 199(4):e550

    Google Scholar 

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  1. Guy’s and St Thomas’ NHS Foundation Trust, Renal Offices Borough Wing, Guy’s Hospital, Great Maze Pond, London, SE1 9RT, UK

    Daniel Ness & Jonathon Olsburgh

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  1. Daniel Ness
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  2. Jonathon Olsburgh
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Contributions

DN protocol/project development—contributed. Data collection or management—contributed and led literature search. Data analysis—led analysis of recent and important papers in field. Manuscript writing/editing—led writing and editing. JO protocol/project development—led design and outline of review structure and themes. Data collection or management—contributed to literature search. Data analysis—contributed to analysis and critique of papers for inclusion. Manuscript writing/editing—contributed to editing. Provided expert supervision and direction.

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Correspondence to Daniel Ness.

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Ness, D., Olsburgh, J. UTI in kidney transplant. World J Urol 38, 81–88 (2020). https://doi.org/10.1007/s00345-019-02742-6

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