Purpose: Describe the incidence of early urinary tract infections (UTI) after renal transplantation at a large academic transplant center. Evaluate the impact of early UTIs on 1 year renal graft function.

Methods: Retrospective chart review was conducted of renal transplant recipients from January 1, 2002 to December 31, 2010. Recipients who experienced a UTI within the first 3 months after transplant were compared with a cohort of patients who did not experience a UTI within the first year after transplant. Outcomes analyzed included baseline serum creatinine (SCr), proportion of patients with SCr increase of >0.5mg/dL and graft failure.

Results: A total of 981 patients were included in this analysis. 74 patients experienced at least 1 UTI within the first 3 months of transplant. Ureter stents had been placed in 70% of these patients. In 20 of 74 patients, early UTI resulted in sepsis. Causal organisms were available for 55 patients with early UTI and included Citrobacter (n=1), E. coli (n=13), Enterobacter (n=5), Enterococcus (n=9), Klebsiella (n=11), Pseudomonas (n=9), Salmonella (n=1), S. aureus (n=1), S. epidermidis (n=4) and S. algalactae (n=1). Twenty six (47%) of the organisms isolated were multi-drug resistant.

Of the patients experiencing early UTIs, 48 (65%) were on sulfamethoxazole/trimethoprim (SMX/TMP) at the time of diagnosis. None of these patients had an organism sensitive to SMX/TMP isolated as the cause of UTI.

Table 1 shows the differences in mean SCr between the UTI and control cohorts at several time points within the first year post transplant. Baseline SCr was that recorded immediately prior to UTI or at 1 month post-transplant in the control group.

In the UTI group 58.1% of patients had an increase in SCr > 0.5mg/dL from baseline to peak, compared to only 19.5% of the control group (p=<0.001). The rate of graft loss at 1 year was 5.4% in the UTI group compared with 0.9% in the control group (p=0.001). The cause of graft loss in the UTI group included rejection (n=2), complication of mitral valve repair (n=1) and complication of SVC syndrome (n=1).

Conclusion: UTI early after renal transplant resulted in an increase in SCr at 6 months; however by 12 months after transplant these differences were no longer apparent. Importantly, patients with early UTI had increased incidence of graft failure within the first year after transplant.

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