Methenamine for the Prevention of Recurrent UTIs Post-Renal Transplant

A. Bigness¹, S. Mohamed², S. Mandala¹, N. Khodieva², K. Robichaux³, H. Mohammed¹, J. Buggs⁴, A. Kumar¹, A. Brueckner⁵, L. Bowman⁵

¹Morsani College of Medicine, University of South Florida, Tampa, FL, ²College of Public Health, University of South Florida, Tampa, FL, ³Honors College, University of South Florida, Tampa, FL, ⁴Transplant Surgery, Tampa General Hospital, Tampa, FL, ⁵Department of Pharmacology, Tampa General Hospital, Tampa, FL

Meeting: 2021 American Transplant Congress

Abstract number: 777

Keywords: Infection, Kidney transplantation, Prophylaxis

Topic: Clinical Science » Infectious Disease » Kidney Infectious Non-Polyoma & Non-Viral Hepatitis

Session Information

Session Name: Kidney Infectious Non-Polyoma & Non-Viral Hepatitis

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Urinary tract infections (UTIs) are a highly prevalent postoperative complication in kidney transplant recipients (KTRs), occurring in approximately 34% of patients. The common method for UTI prophylaxis is systemic antibiotics; however, this practice is associated with an increased risk of drug resistance. Methenamine has been proposed as a bacteriostatic alternative for the prevention of recurrent UTIs, but data is limited in the KTR population. The purpose of this study was to evaluate differences in outcomes in kidney transplant patients before and after the implementation of methenamine for recurrent UTIs.

*Methods: A retrospective, single-center, pre-post cohort study of adult (>18 years old) KTRs transplanted from 2012-2019 who received methenamine for the prevention of recurrent UTIs was conducted. The primary endpoint was the change in UTI incidence after methenamine initiation.

*Results: A total of 902 patients received a kidney transplant during the study period, of which, 38 patients received methenamine for the prevention of recurrent UTIs. After initiation of methenamine, there was a significant decrease in the incidence of UTIs (2.42 vs 0.77, p<0.0001). Additionally, there were significantly fewer overall admissions (3.39 vs 1.5, p<0.001) and admissions for UTIs (1.47 vs 0.44, p<0.0001) post-methenamine initiation. Methenamine had one reported adverse event (rate of 2.8%) with no increase in crystalluria (p= 0.995).

*Conclusions: Methenamine boasts a low-risk profile and was shown to have no increased incidence of crystalluria. There was an associated decrease in the average number of UTIs, admissions, and admissions for UTI after patients were initiated on methenamine. This study adds to the paucity of data on methenamine for the prevention of recurrent UTIs in KTRs. Methenamine is a promising prophylactic agent that should be considered for use in KTRs. Future studies like a randomized controlled trial are necessary to ascertain methenamine’s full prophylactic capabilities in a prospective trial.

To cite this abstract in AMA style:

Bigness A, Mohamed S, Mandala S, Khodieva N, Robichaux K, Mohammed H, Buggs J, Kumar A, Brueckner A, Bowman L. Methenamine for the Prevention of Recurrent UTIs Post-Renal Transplant [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/methenamine-for-the-prevention-of-recurrent-utis-post-renal-transplant/. Accessed May 16, 2025.

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