*Purpose: Symptomatic UTIs (urinary tract infections) cause a significantly detrimental effect on long term graft function. Immunosuppression coupled with underlying renal or urological abnormality makes treating UTI in these patients complex, often multi-resistant, and difficult to eradicate. We present our initial experience of implementing a multi-disciplinary transplant UTI service.

*Methods: Prospective data on referrals into our clinic was collated between July 2017 & October 2018. All transplant patients with recurrent UTIs were eligible for review. Patients were seen as per transplant follow-up regime thus not requiring additional clinic visits. All new patients answered a quality of life questionnaire, had a urine dip, observations, bloods and a post-void bladder scan. They were first seen for UTI ‘care bundle’ advice from our transplant nurse specialist. The number of subsequent UTIs, impact on graft function and quality of life (QOL) data at presentation and discharge was analysed.

*Results: 33 multidisciplinary clinics were held during the study period with interval multidisciplinary meetings to discuss complex cases. 116 new transplant patients were seen and followed up on 68 occasions. 21 appointments were lost through non-attendance. 15 patients were discharged after their first visit. Of these, only 14/116 were SPK patients. The median number of UTIs prior to presentation was 2 with a 71% female predominance and mean age 50 years. The cause of end stage renal failure was intrinsic renal disease 27%, diabetic nephropathy 22%, adult polycystic kidney disease 15%, vesico-ureteric reflux 15% and congenital urological disease 11%.

The median time between transplantation and initial assessment was 73 months (range 6-469 months). 41% were referred within 5 years post-transplant, and 17% were referred within 2 years post-transplant. 34 patients have completed 1 year follow-up with a mean improvement in graft function of 34µmol/l. For referral into clinic alone, each new patient generated £383 and each follow-up £183. This is a total of £56 872 income generated.

*Conclusions: With antimicrobial resistance predicted to become the leading cause of death by 2050, there is a pressing need to identify risk factors, intervene early and impose antibiotic stewardship in these patients. Establishment of a transplant UTI clinic provides a pathway of specialist targeted care and facilitates investigations that accurately identify infectious foci.

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