High prevalence of febrile urinary tract infections after paediatric renal transplantation

Background. Adult data suggest that urinary tract infections occur frequently after renal transplantation (RTx) and contribute to mortality and graft loss; data in children are limited. Therefore, we evaluated prevalence, short and long-term morbidity and confounding factors of febrile UTI (fUTI) after paediatric RTx. Methods. In a retrospective cross-sectional study of three centres, we analysed data on 110 children followed for 4.9 ± 3.4 years after successful transplantation. Results. 40/110 (36%) patients had at least one fUTI at a median time of 0.98 years (range 0.02–8.96) after RTx; 11 patients (28%) had recurrent fUTI. Serum creatinine (SCr) rose significantly from 1.15 ± 1.13 to 1.83 ± 1.69 mg/dl, (P < 0.001) during the fUTI, declining to baseline values after treatment. At the last followed-up calculated mean, GFR was comparable between fUTI and non-fUTI groups (75 ± 26 vs 71 ± 22 ml/min/1.73 m2). During fUTI mean, C-reactive protein (CRP) increased to 123 ± 75 mg/l. Febrile UTI were significantly more frequent in girls compared to boys (22/44 vs 18/66, P < 0.05) but occurred significantly earlier in boys than in girls [median 0.63 (range 0.02–4.15) vs 1.07 (0.04–8.96) years after RTx; P < 0.02]. Also, patients with urinary tract malformations (UTMs) and neurogenic bladder as underlying diagnosis and those with urological surgery prior to transplantation had an increased risk for fUTI. Conclusion. fUTI is a frequent complication with significant short-term morbidity especially in girls and children with UTMs, neurogenic bladder and those with urological surgery. Long-term follow-up and prospective studies confirming specific risk factors, preventive measures and impact on graft survival are necessary.