Inzidenz, Outcome und Relevanz von Harnwegsinfekten und Harnleiterstenosen bei nierentransplantierten Patienten
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Philipps-Universität Marburg
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Abstract
Urinary tract infections (UTIs) pose a relevant problem in patients after kidney
transplantation and have a possible impact on graft function and graft survival. While UTIs may trigger a graft rejection, renal obstructions can also play a role in fostering UTIs in this cohort. The objective of this study was to assess incidence of UTIs and the role of the specific infections as well as the impact of ureter stenosis on kidney transplant outcome at the Marburg Transplant Center.
We retrospectively evaluated data from adult patients who had received a kidney (NTx) or combined kidney-pancreas transplant (NPTx) from January 2012 until July 2020 with a follow-up of at least 3 months. Incidence of UTIs and the pathogens as well as prevalence of ureter stenosis were noted. Epidemiologic data, cold and warm ischemia time, immunological parameters and comorbidities were extracted from patient charts and the electronic data system; and a potential association with UTIs was evaluated. Data was analyzed using chi-square test, exact Fisher’s test or the Bonferroni method; a p-value <.05 was considered significant.
A total of 152 transplant recipients (average age 51.8 years, range 19-75; male 59.2%, 132 NTx, 20 NPTx) were included. UTIs were most common within the first 3 months after transplantation (4.1±2.3 times; range 0-10). Almost 50% of the patients had more than 10 UTIs within 24 months after NTx or NPTx, often with multiple pathogens. Most common bacteria were enterococcus or staphylococcus species (74.3%) followed by undifferentiated gram-negative rods (63.2%) and E. coli (69.1%). In almost half of the patients (48.7%) enterococcus faecium was shown to be present. Graft loss was observed in 15 patients (9.9%), while 129 individuals still had a functioning transplant kidney at a follow-up of up to 8 years; no data was available in the remaining patients. Of note, patients with graft loss had significant more UTIs within the first 24 months compared to the cohort without graft loss (p=.009). Although the incidence of UTIs was comparable in both groups in the beginning, this number declined over time in patients without graft loss, whereas it remained high in those with deteriorating renal function. UTIs due
to staphylococcus epidermidis and candida species were associated with an
increased risk for transplant failure. A ureter stenosis developed in 27 patients (18%), associated with an increasing number of UTIs (p<.05), especially when staphylococcus epidermidis or enterococcus faecalis were present. Histo logically proven graft rejections occured in 62 patients (40,8%), demonstrating a potential association with the underlying renal disease. Morevover, a cold ischemia time (CIT) ≥ 16 hours resulted in significantly more rejection episodes (p=.028), while duration of warm ischemia time apparently did not have an impact on renal outcome.
In conclusion, we showed that: (1) UTIs are common in the first 3 months after kidney transplantation; (2) the number of UTIs as well as specific germs are associated with an increased risk for renal graft loss; (3) development of a n ureter stenosis may be related to prior UTIs; and (4) the risk for graft rejection is significantly associated with a long CIT. Targeted antibiotic therapy and reduction of CIT are essential means to improve renal graft outcome.
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Dates
Created: 2024Issued: 2024-05-15Updated: 2024-05-15
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Nierentransplantationgraft functionTransplantatfunktionHarnwegsinfektionenAbstoßungen,Transplantatverluste/überlebenKidney transplantationureteral stenosisHarnleiterstenosenUrinary tract infectionsrejection
DFG-subjects
NierentransplantationNTxUTIUreterale StenosenHarnleiterstenoseHarnwegsinfektHWIHarnwegsinfektionen
DDC-Numbers
610
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Blattmann, Ann Kristin: Inzidenz, Outcome und Relevanz von Harnwegsinfekten und Harnleiterstenosen bei nierentransplantierten Patienten. : Philipps-Universität Marburg 2024-05-15. DOI: https://doi.org/10.17192/z2024.0172.