*Purpose: Urine cultures are frequently sent in the first year after kidney transplant, but the reasons that testing is done post-transplant is not well understood. Understanding why clinicians order testing is key for implementing diagnostic stewardship

*Methods: We used the United States Renal Data System’s Institution and Physician Supplier files to identify urine cultures (HCPCS codes 87086 and 87088) for patients who underwent kidney transplant 2006-2014 with at least one year follow up with an intact graft. We used ICD-9 codes from the same day as urine cultures to identify the reasons patients underwent outpatient urine culture testing.

*Results: 64838 patients underwent a total of 672152 urine cultures in the first year post transplant. Reasons for urine culture ordering included suspected UTI (27.23%), fevers/chills (1.74%), urinary symptoms (9.66%), suspected pyelonephritis (1.36%), suspected sepsis (0.30%), nausea/vomiting (1.13%), fatigue (2.92%), abdominal pain (2.24%), abnormal labs (4.87%), pregnancy (0.15%), pre-procedural testing (0.72%), altered mental status (0.51%), or suspected bacterial infection (0.11%). Most urine cultures were not associated with any of the above diagnoses (56.0%); 90.4% of these urine cultures were associated with generic post-transplant diagnosis codes. Significant center-to-center variation was seen in the median number of urine cultures ordered per patient in the first year after transplant (p<0.01).

*Conclusions: Only a minority of urine cultures ordered in the first year after transplant 2006-2014 were associated with diagnosis codes suggesting a concern for infection; over 50% were associated with post-transplant diagnosis codes. Further studies should examine in further detail the reasons for center-to-center variation in urine culture ordering and the association with antibiotic ordering, to enable diagnostic stewardship in this population.

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