Abstract

Background: Urinary bladder augmentation or urinary diversion may be necessary for successful kidney transplantation in patients with serious lower urinary tract abnormalities. Reconstruction of urine collecting system may be performed either prior to or at the time of transplantation. Urinary tract infections (UTI) are common in this subset of patients and potentially threatening to graft survival. Aim of the study: To evaluate risk factors of serious, recurrent urinary tract infections (defined as more than one UTI episode requiring hospitalization or urosepsis) in patient with simultaneous to engraftment ileal conduit operation or two-stage surgical protocol.
Material/Methods: In retrospective analysis we identified 24 adult kidney
recipients transplanted between 1999-2008 with severe lower urinary tract
abnormalities requiring reconstruction. In 14 patients ileal loop was created at engraftment, in 7 prior to procedure; 2 patients had continent urine reservoir with Mitrofanoff fistula, 2 bladder augmentation, one cutaneous ureterostomy.
Results: Mean post-transplant follow-up was 33.6±28 month, kidney allograft survival excellent - 97%, and serum creatinine 1.29±0.42 (range 0.9-2.6) mg/dl at the end of observation. Two patients lost their grafts - one kidney was removed because of recurrent bacterial and fungal sepsis, other patient reentered dialysis because of recurrent pyelonephritis. 88% (n=21) of patients had at least one episode of urinary tract infection and 67% (n=16) of them
required in-hospital care. In control group (matched in 1: 3 ration for engraftment date, recipient age and gender) UTI incidence was significantly lower, 44% (n=30), p<0.001. We evaluated the relation between listed parameters and the risk of UTI: recipient gender, living vs. deceased donor, CMV disease, chronic hepatitis, quadruple immunosuppressive regiment, acute rejection episodes, simultaneous with transplantation vs. two stage procedure. The only parameter associated with significantly increased UTI risk was CMV decease (HR 5.9-10, p<0.02
Conclusions: Collecting system reconstruction increases the risk of urinary tract infections (UTI in kidney allograft recipients. We couldn't identify additional, potentially modifiable risk factors of infectious complications. As recipients with urine collecting system abnormalities are on average of small immunological risk, substantial maintenance immunosuppression reduction may help to control infections.

Keywords: Kidney Transplantation