Post-Transplant UTI Not Linked to Ureteral Stents
Poorvi Chordia, MD
VANCOUVER—Ureteral stents are not associated with an increased risk of urinary tract infection (UTI) following renal transplantation, according to new findings presented at the 48th Annual Meeting of the Infectious Diseases Society of America (IDSA).
Researchers at the University of Florida in Gainesville studied 395 renal transplant patients, of whom 212 received a ureteral stent and 183 did not. All stent removals were performed at six weeks and the follow-up period was 12 months post-transplant. The stent group (STG) had three follow-up intervals: prior to stent removal, six weeks after stent removal, and six weeks to one year post-transplant. In the non-stent group (NSTG), follow-up was divided into 0-6 weeks, 6-12 weeks, and from 12 weeks to one year post-transplant. UTIs were defined using the IDSA criteria.
The overall incidence of UTI within one year post-transplantation was similar between the STG and NSTG (19% and 22.5%, respectively). The incidence of UTI also was similar between the STG group prior to stent removal and the NSTG at 0-6 weeks post-transplant (9.1% and 9.7%).
The incidence of UTI from six weeks after stent removal in the STG and 6-12 weeks in the NSTG was 5.8% and 6.7%, respectively. From 12 weeks to one year post-transplant, the incidence was 10.8% and 13.3%, respectively.
Female recipients had a 2.5-fold increased odds of a UTI compared with male recipients. Delayed graft function increased the odds twofold. Post-operative Foley catheterization was associated with 4.7 times increased odds.
“We really found that putting stents in or not putting stents in does not make a difference when it comes to urinary tract infections,” said investigator Poorvi Chordia, MD, a resident in internal medicine at St. Joseph's Hospital in Ann Arbor, Mich. “These findings are clinically relevant because urologic surgeons can now do what they are most comfortable doing. If a surgeon is comfortable putting in stents, then it appears to be fine because it doesn't appear to increase major urological complications.”
UTIs are the most common infectious complication following renal allograft transplantation, she noted. In one study, ureteral stents were associated with a 1.5 times increased relative risk for UTI. Stents can increase the risk of UTI because they are foreign bodies that require instrumentation for removal, Dr. Chordia said. In addition, stents interfere with the submuscular anti-reflux mechanism, increasing the risk of vesico-ureteral reflux, she explained.