*Purpose: Evaluate efficacy of methenamine for prevention of recurrent urinary tract infections (rUTI) in transplant recipients.

*Methods: This retrospective review included patients greater than or equal to 18 years of age who received an abdominal transplant at University Transplant Center with rUTI from 1/2009 to 9/2019. rUTI were defined as greater than or equal to 2 UTI within 6 months or 3 UTI within a year documented by cultures with greater than 10,000 Colony Forming Units. Patients who met rUTI diagnostic criteria were divided into the following groups: (1) Methenamine: received methenamine for greater than or equal to 90 days or (2) No Prophylaxis: did not receive rUTI prophylaxis. Patients on concomitant bacterial suppression therapy for rUTI were excluded. Rate of rUTI, treatment failure, bacteremia, hospitalization, and isolation of multi-drug resistant organism (MDRO) were assessed per 90 patient-days follow-up. A matched pair analysis compared 90-days pre-methenamine therapy initiation (MTI) to post-MTI. Results were reported per 90 patient-days follow-up. Median of average duration of antibiotic days was collected in all groups.

*Results: A total of 62 patients were included. Time from rUTI diagnosis to MTI was 480 days (IQR 188-1508). Endpoints were significantly reduced in the methenamine group compared to no prophylaxis (Table 1). Matched pair analysis (pre-MTI vs post MTI) revealed a decrease in rUTI, hospitalization, and antibiotic days in post-MIT group (Table 2).

*Conclusions: To our knowledge, this is the first study evaluating the efficacy of methenamine to patients receiving no prophylaxis for rUTI in abdominal transplant recipients. This study supports MTI for rUTI in abdominal transplant recipients to reduce rate of rUTI, treatment failure, bacteremia, hospitalization, and MDRO isolated. Significant reduction in rUTI was also evident when evaluating cohorts pre- and post-MTI.

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