Objectives: Urinary tract infection (UTI) is the most common infection complication after kidney transplantation, and the reports of the incidence vary greatly among different centers. This study aims to explore the risk factors for UTI after kidney transplantation with the donation from brain death (DBD) and the impact on graft function, thus to provide theoretical basis for comprehensive prevention and treatment of UTI after kidney transplantation.
Methods: The clinical and laboratory data of DBD kidney transplantation from January 2017 to December 2018 in Xiangya Hospital, Central South University were collected and retrospectively analyzed. Patients were assigned into an UTI group and a non-UTI group. The base line characteristics, post-transplant complications, and graft function were compared between the 2 groups. Multivariate logistic regression was used to analyze the risk factors for UTI.
Results: A total of 212 DBD kidney transplant recipients were enrolled in this study. UTI occurred in 44 (20.75%) patients after transplantation. The female, the time of indwelling catheter, and postoperative urinary fistula were independent risk factors for UTI after DBD kidney transplantation. A total of 19 strains of gram-positive bacteria, 12 strains of gram-negative bacteria , and 10 strains of fungi were isolated from the urine of 44 UTI patients. The UTI after kidney transplantation significantly increased time of hospital stay (P<0.001) and raised the cost for antibiotics (P=0.004). The graft function was much worse in the UTI group compared with the non-UTI group (P<0.001) at 3 months after transplantation. Twenty (45.45%) patients recurred UTI within one year after transplantation. Non-hemodialysis before transplantation and perioperative combination of antibacterial and antifungal drugs were independent risk factors for recurrence of UTI.
Conclusions: UTI after DBD kidney transplantation transplantation affects the renal function at 3 months and increases the patient's economic burden.
目的: 尿路感染是肾移植术后常见的并发症，不同器官移植中心报道的发生率差异较大。本研究拟探讨脑死亡器官捐献(donation after brain death，DBD)肾移植术后尿路感染发生的危险因素及其对移植肾功能的影响，为肾移植术后尿路感染的综合防治提供理论依据。方法: 回顾性分析中南大学湘雅医院2017年1月至2018年12月DBD肾移植供者和受者的临床和实验室资料。根据术后3个月内是否发生尿路感染将患者分为尿路感染组和无尿路感染组，比较两组之间临床资料及预后的差异；采用多因素logistic回归分析肾移植术后尿路感染的危险因素。结果: 212名DBD肾移植患者中有44名(20.75%)患者术后3个月内发生尿路感染，女性受者、留置导尿管时间长以及术后尿瘘是尿路感染的独立危险因素。44名尿路感染患者尿液共分离出革兰氏阳性菌19株，革兰氏阴性菌12株，真菌10株。尿路感染显著延长肾移植术后住院时间(P<0.001)，增加肾移植围手术期的抗菌药物费用(P=0.004)。尿路感染组术后3个月的肾小球滤过率较无尿路感染组更低(P<0.001)。肾移植术后1年内有20例(45.45%)患者复发尿路感染，术前非血液透析方式、围手术期联合使用抗细菌和抗真菌药物是复发尿路感染的独立危险因素。结论: DBD肾移植术后尿路感染影响患者的短期的移植肾功能，增加患者的经济负担。.
Keywords: brain death; graft function; kidney transplantatlon; risk factors; urinary tract infection.