Urinary Tract Infections after Kidney Transplantation and their Associated Factors

Abstract

Background: Many of the patients undergoing kidney transplantation (KT) are prone to urinary tract infections
(UTIs) due to reasons such as ureter manipulation and damage during surgery, prolonged insertion of urinary
catheters, and developing neurogenic bladder. Despite notable progress in surgical techniques and immunosuppression methods after kidney transplantation, UTIs persist as an important conundrum in these patients,
predisposing them to morbidities and mortality.
Objective: Therefore, this study aimed to investigate the factors associated with UTIs in patients undergoing
kidney transplantation.
Methods: In this follow-up analysis, 69 patients receiving KT under the supervision of the nephrology clinic of
Shahid Mostafa Khomeini Hospital of Ilam city, Iran, from 2016 to 2018 were followed up in terms of developing post-transplant UTIs. All patients were examined for underlying diseases, renal failure, post-transplant
UTI and its frequency, asymptomatic or symptomatic UTI, post-UTI renal function, type of organism, and drug
resistance. The data gathered were analyzed using the firth logistic regression by STATA software version 12.
Results: In this study, the first signs of UTIs appeared within one-month post-transplantation in 15.4% of the
patients and within 12 months in 42.3% of them. No drug resistance was observed in 50% of the patients.
Recurrent UTIs after transplantation was noticed in 57.6%. During the follow-up, all patients experienced at
least one symptomatic UTI, and 38.5% of them developed asymptomatic UTIs at least once. In addition, kidney
function decreased in 38.5% of the patients developing UTIs, and this rate was 25% among those who had
symptomatic infections and 60% in individuals experiencing both symptomatic and asymptomatic UTIs. In
multivariate analysis, advanced age (OR= 1.07, 95% CI: 1.02-1.13, P= 0.01) and female gender (OR= 13.10, 95%
CI: 2.75-64.74, P= 0.002) were identified as independent risk factors for UTIs, while vitamin D level (OR= 0.94,
95% CI: 0.89-1.00, P= 0.05) was found to be a protective factor for UTIs after KT.
Conclusion: According to our results, the incidence of UTIs in patients receiving renal grafts was higher in women than in men. Vitamin D level was identified as a protective factor against post-transplant UTI. All patients
undergoing KT experienced symptomatic UTIs at least once, 38.5% of whom also revealed a decrease in renal
function. Therefore, it is recommended to educate health professionals regarding the early signs of UTIs and
their risk factors so that effective preventive measures can be implemented to avoid UTIs, subsequent dysfunction of the transplanted kidney, and patient death.