Renal transplant remains one of the most effective methods of treating end-stage renal disease in the US. However, with an increasing demand for renal transplant and extended wait times for patients receiving a renal transplant, it remains imperative to reduce complications that could decrease graft function. In renal transplant patients, urinary tract infection (UTI) remains one of the most common complications. Given its association with poorer graft function and patient survival, methods to reduce UTI in this subset of patients is important. If allowed to progress to urosepsis, the detrimental effects on graft function and patient morbidity and mortality are exacerbated. While antibiotic prophylaxis and immunosuppression adjustment have drastically reduced the incidence of UTI after renal transplant, the rate of serious complications remains high. Our objective is to evaluate factors associated with UTI and urosepsis in renal transplant patients to better identify patients at risk.

We hypothesize that there will be a correlation between a history of recurrent UTI or urinary retention with the development of postoperative UTI or urosepsis requiring hospitalization.

A retrospective chart review was conducted examining 651 consecutive patients undergoing renal transplant between August 1, 2016, and July 30, 2019, at a tertiary care academic center.  Patient demographics, medical history, surgical history, type and time on dialysis, and oliguria were collected. Primary outcomes examined were the occurrence of UTI and the occurrence of urosepsis with required hospitalization within one year of transplant. Variables were compared using Pearson’s chi-squared test and the duration of dialysis was evaluated using a two-sample t-test in Stata.

Of the 651 patients undergoing renal transplant, 84 (13%) developed a UTI within 1 year of transplant. Compared to patients who did not have a UTI, those who developed a UTI post-transplant were more likely to have Diabetes Mellitus (Type 1 or 2) (56% vs 44%, p=0.033) and anuria (<100mL of urine/day, 37% vs 26%, p=0.039) prior to their transplant. 

A similar trend was seen in patients who had to be hospitalized for urosepsis. They tended to be anuric (38% vs 27%, p=0.065) and were on dialysis longer (1599 vs 1244 days, p=0.0555) at the time of their transplant than patients who did not have to be hospitalized for urosepsis (Table 1). Of the 52 urosepsis patients, 6 (12%) underwent cystoscopy and 2 (4%) underwent voiding cystourethrography (VCUG).

There are identifiable risk factors associated with the development of UTI and urosepsis requiring hospitalization after transplantation. Based on the analysis for UTI, patients with a history of diabetes or who are anuric are at a higher risk of developing UTI and should be followed closely to protect their graft function. None of the measures we examined were significant factors in developing urosepsis. However, longer mean duration of dialysis for urosepsis patients did approach significance (p=0.0555). These factors may help identify patients that may require adjustment in their immunosuppression regimen and antibiotic prophylaxis.

UTI and urosepsis develop after renal transplantation in a small subset of patients. This is the first study to identify patient factors associated with UTI and urosepsis hospitalizations in this contemporary cohort.