Urinary Tract Infections in Children with Kidney Allografts: Risk Factors and Clinical Consequences Open Access

Abstract

Kidney transplantation is the optimal treatment for children with end stage renal disease (ESRD). Urinary tract infections (UTIs) are the most common bacterial infection post-kidney transplant and are a significant cause of morbidity in this population. Pediatric patients are at increased risk of UTIs due to the etiology of their ESRD. The morbidity of UTIs and their impact on long-term allograft survival has not been studied.

We conducted a retrospective cohort analysis and record review of pediatric kidney transplant recipients to investigate three main aims: determine risk factors for recurrent UTIs; assess the effect of recurrent UTIs on kidney transplant outcomes; and determine the rate of hospitalizations and frequency of AKI secondary to UTI. Inclusion criteria included receiving a kidney transplant at our pediatric tertiary referral center between 2006 and 2016. Patients with less than one year of documented follow-up were excluded. There were 262 eligible patients. Data was collected up to two years following the date of transplantation.  

The median age at transplantation for these patients was 12.43 years (interquartile range: 6.45 – 15.83). Thirty patients (11.6%) had recurrent UTIs in the first year post-transplant and 18 (7.5%) had recurrent UTIs in the second year post-transplant. Thirty-eight patients (14.5%) had recurrent UTIs in the two years post-transplant. When comparing patients with obstructive uropathy to patients with glomerular disease, the odds ratio to develop recurrent UTIs in the first or second year post-transplant was 5.627.

 Patients with recurrent UTIs during the first post-transplant had a greater decrease in eGFR than patients without recurrent UTIs (-19.77 vs -1.04 mL/min/1.73 m²; p= 0.0053). Per 100 patients, patients with obstructive uropathy had a hospitalization rate of 0.695 compared to 0.076 in patients without obstructive uropathy (p value: 0.00053). AKI was associated with UTI in 19 patients (7.3%) during the first two years post-transplant.

In pediatric kidney transplant recipients, recurrent UTIs cause significant morbidity and are associated with loss of kidney function. Additional prospective studies are needed to further understand this association and develop strategies for decreasing the morbidity from recurrent UTIs in this patient population. 

Table of Contents

Introduction - Page 1

Background - Page 2 to Page 4

Methods - Page 5 to Page 9

Results - Page 10 to Page 13

Discussion - Page 14 to Page 17

References - Page 18 to Page 19

Tables - Page 20 to Page 30

Figures - Page 31 to Page 34

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, General Health Sciences, Epidemiology Health Sciences, Surgery
Keyword	Nephrology Kidney Transplant UTI
Committee Chair / Thesis Advisor	Henry Blumberg, Emory University Larry Greenbaum , Emory University
Committee Members	Traci Leong, Emory University Jeffrey Collins, Emory University Mitchel Klein , Emory University

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