Effect of Urinary tract infection on the outcome of the Allograft in patients with Renal transplantation

Abstract Background Urinary Tract Infections (UTIs) are the second most common cause of graft dysfunction, accounting for significant morbidity, and are associated with poor graft and patient survival. This study aimed to determine the association between post-renal transplant UTI and graft outcomes. Methods We examined the effect of UTIs on graft outcomes in patients who underwent renal transplantation surgery between January 2010 and December 2022. The study population included 349 renal transplantations, of which 74 experienced 140 UTI events. Based on the number of UTI episodes, patients were categorized into three groups Results Of the 349 recipients, 275 (74.4%) had no UTI, 47 (18.8%) had nonrecurrent UTIs (NR-UTIs), and 27 (6.8%) had Recurrent UTIs (R-UTIs). NR-UTIs were associated with very poor graft survival compared with no UTI (Hazard Ratio HR, 2.312; 95% Confidence Interval CI, 1.410–3.791; P=0.001). This relationship persisted even after adjusting for confounding factors in Multivariable Cox regression analysis (HR, 2.318; 95% CI, 1.414–3.800; P=0.001). Although R-UTIs appeared to result in poor patient survival, the difference was not significant (vs No UTI, HR, 1.517; 95% CI, 0.983–2.342; P=0.060). There appeared to be higher patient survival in R-UTIs but was not significant (vs NR-UTI, HR, 1.316; 95% CI, 0.486–3.564; P=0.589). R-UTIs were more likely to be associated with Multi-drug Resistant Gram-negative organisms (Klebsiella pneumonia or Escherichia coli) with resistance to Nitrofurantoin (RR, 2.753; 95% CI, 1.257–6.032; P=0.01) and Carbapenem (RR, 2.064; 95% CI, 0.988–4.314; P=0.05). Conclusion NR-UTIs were associated with poorer graft and patient outcomes than no UTI.