Santithanmakorn Chayanan, Vanichanan Jakapat, Townamchai Natavudh, Jutivorakool Kamonwan, Wattanatorn Salin, Sutherasan Methee, Opanuruk Julin, Kerr Stephen J, Praditpornsilpa Kearkiat, Avihingsanon Yingyos, Udomkarnjananun Suwasin
Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
Biomedicines. 2022 Nov 20;10(11):2984. doi: 10.3390/biomedicines10112984.
Risk factors and consequences of urinary tract infection (UTI) post-kidney transplant have been variously reported by studies that were heterogenous in immunosuppressants and prophylactic protocols. We aimed to clarify the risks and consequences of UTI in kidney transplant recipients with post-transplantation cotrimoxazole prophylaxis in the context of modern immunosuppression. This retrospective cohort included kidney transplant recipients receiving tacrolimus, mycophenolate, prednisolone, and cotrimoxazole for bacterial UTI prophylaxis. Recipients were categorized into non-UTI and UTI groups. Asymptomatic bacteriuria (ASB) was screened in the first 3 months and was evaluated for association with UTI. Of 348 kidney transplant recipients, 129 were in the UTI group and 219 in the non-UTI group. UTI risk factors were female sex, body mass index ≥ 25 kg/m, human leukocyte antigen mismatch, and panel reactive antibody ≥ 50%. Recipients with recurrent UTI had inferior allograft function compared with non-UTI recipients. Patient survival was significantly lower in recipients with UTI in the first post-transplant month. Higher degree of immunosuppressions was associated with recurrent UTI and drug-resistant organisms. In conclusion, UTI continues to negatively affect graft function and survival of kidney transplant recipients. Treating ASB in the first 3 months did not reduce the UTI incidence in the first transplantation year.
关于肾移植后尿路感染（UTI）的危险因素和后果，在免疫抑制剂和预防方案各异的研究中有不同的报道。我们旨在阐明在现代免疫抑制背景下，接受移植后复方新诺明预防的肾移植受者发生UTI的风险和后果。这项回顾性队列研究纳入了接受他克莫司、霉酚酸酯、泼尼松龙和复方新诺明预防细菌性UTI的肾移植受者。将受者分为非UTI组和UTI组。在最初3个月筛查无症状菌尿（ASB），并评估其与UTI的相关性。348例肾移植受者中，129例在UTI组，219例在非UTI组。UTI的危险因素为女性、体重指数≥25kg/m²、人类白细胞抗原错配以及群体反应性抗体≥50%。与非UTI受者相比，复发性UTI受者的移植肾功能较差。移植后第一个月发生UTI的受者的患者生存率显著较低。更高程度的免疫抑制与复发性UTI和耐药菌有关。总之，UTI继续对肾移植受者的移植肾功能和生存产生负面影响。在最初3个月治疗ASB并未降低首次移植后第一年的UTI发生率。
