Five compelling UTI questions after kidney transplant
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TOPIC PAPER
Five compelling UTI questions after kidney transplant Selda Aydın1 · Abhijit Patil2 · Mahesh Desai2 · Nasser Simforoosh3 Received: 18 September 2019 / Accepted: 17 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Urinary tract infection (UTI) is the most common bacterial infection among infectious complications in kidney transplant recipients (KTR). After transplantation, infections can result from surgical complications, donor-derived infections, pre-existing recipient infections, and nosocomial infections. Post-transplant infection is still a major cause of morbidity, mortality, graft dysfunction and rejection. In this paper, we aimed to review a few compelling questions in kidney transplantation (KTX). Methods To identify relevant clinical questions regarding KTX and UTI a meeting was conducted among physicians involved in the KT program in our hospital. After discussion, several clinically relevant questions related to UTI after KTX. The 5 first rated in importance were judged generalizable to other clinical settings and selected for the purposes of this review. Results Nearly half of the patients present in the first three months of transplant with UTI. The most common uropathogens in post-transplant UTIs are Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Risk factors for UTI include female sex, advanced age, recurrent UTI before transplant, prolonged urethral catheterization, delayed graft function, and cadaveric kidney transplant. Conclusion The incidence of post-transplant UTI is similar in both developed and developing countries. E.coli is the most common pathogen in most of studies. Cadaveric donor and post-dialysis transplantation are defined as independent risk factors for post-transplant UTI. Further studies are still required to identify risk factors after kidney transplantation and UTI’s importance for graft function and patient outcome. Keywords Urinary tract infection · Kidney transplantation · Cadaveric donor · Pre-emptive transplantation
Introduction It is estimated that between 10 and 16% of the adult population will eventually develop chronic kidney disease worldwide [1]. End-stage renal disease requires renal replacement treatment (RRT) that includes dialysis or kidney transplantation (KTX). In 2013, the overall incidence at day 91 after the onset of RRT was 181 per million population (pmp) for Latin American countries and 130 pmp for European * Selda Aydın [email protected] 1
Infectious Diseases and Clinical Microbiology, Medipol Mega Hospital, Istanbul Medipol University School of Medicine, Bağcılar, Istanbul, Turkey
2
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
3
Department of Urology, Shahid Labbafinejad Medical Center, Tehran, Iran
countries [2]. KTX is a more affordable and better method compared to dialysis and improves long-term survival and quality of life [3, 4]. The main purpose of renal transplant is to restore renal function. To optimize, maintain
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