Incidence of Early Urinary Tract Infections and Relationship to Subsequent Rejection Episodes in Renal Allograft Recipients

The purpose of this study was to define the incidence of urinary tract infections (UTI) in the early post-transplant period and to determine whether or not they have any adverse influence on the severity and reversibility of rejection episodes. 166 recipients of 1st allografts (127 recipients of nonliving donor kidneys and 39 recipients of living related donor kidneys) were classified according to whether or not they had UTI during the 1 st month post-transplant. In each group, the number of subsequent rejection episodes within the 1st 6 weeks post-transplant was evaluated, and the rejections were classified as reversible or irreversible. The same evaluation was done for the 127 recipients of nonliving donor kidneys as a subgroup. The summarized results of the latter group are as follows: 52 of 127 patients had UTI for an incidence of 41 %; 40 of 52 patients (77%) with previous UTI compared to 55 of 75 patients (73%) without previous UTI developed rejection episodes. 20% of the rejection episodes were irreversible in the group with previous UTI compared to 24% in the group without previous UTI. Rejections occur with similar frequency in recipients with and without previous UTI in the early post-transplant period. No evidence was found to suggest that post-transplant UTI trigger rejection episodes or are associated with severe rejection crises. However, significantly more patients with UTI than without UTI were anergic to delayed-type hypersensitivity (DTH) skin test antigens pretransplant, had longer dialysis-dependent uremia and had received pretransplant blood transfusions. These latter three interrelated variables are thus considered to be infection-related risk factors.