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Post-Transplant Recurrent UTI Risk Factors — ESENeph MCQ

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ModerateTransplantationPost-Transplant Recurrent UTI Risk FactorsESENeph

A kidney transplant recipient 5 years post-transplant develops recurrent UTIs. She has had 6 episodes in the past 12 months. Her transplant ureteric reimplantation is normal on imaging. What structural and immunological factors predispose transplant recipients to UTI?

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Correct answer: B — Immunosuppression impairs bacterial clearance; the transplanted ureter lacks normal peristaltic innervation; vesicoureteric reflux may occur at the reimplantation site; urinary stasis from denervation and altered anatomy all contribute

Transplant recipients have multiple UTI risk factors: pharmacological immunosuppression (impairs neutrophil and T-cell function), surgical factors (denervated ureter with reduced peristalsis, ureteric stent placement, surgical manipulation), anatomical factors (vesicoureteric reflux at reimplantation site, residual native kidneys as infection reservoirs), and host factors (diabetes, female sex, CKD-associated immune dysfunction). Recurrent UTIs can cause pyelonephritis of the graft, potentially causing graft dysfunction. Prophylactic Co-trimoxazole (given for PJP prophylaxis) also reduces UTI incidence.

Reference: KDIGO 2009 – Transplant; Goldman and Julian 2019 – Post-Transplant UTI