Risk Factors for Perioperative Urinary Tract Infection After Living Donor Kidney Transplantation Characterized by High Prevalence of Desensitization Therapy: A Single-Center Analysis
Abstract
Background/Objectives: Limited evidence exists on risk factors for urinary tract infections (UTIs) in kidney transplant recipients, particularly in high-risk groups such as ABO-incompatible or donor-specific antibody (DSA)-positive cases. Early UTIs, especially within the first month post-transplant, impact on acute rejection and long-term graft outcomes, highlighting the need for risk factor identification and management. Methods: Among 157 living donor kidney transplant cases performed at our institution between 2009 and 2024, 128 patients were included after excluding cases with >72 hours of perioperative prophylactic antibiotics or urological complications. Desensitization therapy (plasmapheresis + rituximab) was performed in 74 cases (58%) for ABO-incompatible or DSA-positive transplantation. UTI was defined as the presence of pyuria and a positive urine culture, accompanied by clinical symptoms requiring antibiotic treatment, occurring within one month post-transplantation. Results: The median onset of UTI was postoperative day 8 (interquartile range; IQR: 6.8-9.3). No subsequent acute rejection episodes were observed. The median serum creatinine at 1 month postoperatively was 1.3 mg/dL (IQR: 1.1–1.7) and this was not significantly different from those who didn’t develop UTI. In univariate analysis, low or high BMI (25), longer dialysis duration (>2.5 years), desensitization therapy, elevated preoperative neutrophil-to-lymphocyte ratio (NLR) (≧3), and longer warm…
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