DO URINARY-TRACT INFECTIONS TRIGGER CHRONIC KIDNEY-TRANSPLANT REJECTION IN MAN

Purpose: Urinary tract infections are frequent after kidney transplant ation but little is known about the Impact on long-term survival. As c hronic rejection is the major cause of graft loss in the long term, we retrospectively analyzed the role of urinary tract infections in this process. Materials and Methods: We included in the study all adult pa tients who received kidney transplants at our unit between 1972 and 19 91, which ensured followup of at least 5 years, and we focused on the relationship between urinary tract infections and the incidence of chr onic rejection episodes. To analyze the influence of urinary tract inf ections on chronic rejection patients were separated into those in who m biopsy proved chronic rejection developed within the first 5 years a fter transplantation (chronic rejection group 225) and those without a pparent signs of chronic rejection during that period (control group 3 51). The correlation between urinary tract infections per year and the incidence of chronic rejection was analyzed. Results: Patients with c hronic rejection had more urinary tract infections per year than contr ols. In the first year after transplantation both groups had the highe st incidence of urinary tract infections but thereafter the rate of ur inary tract infections per year declined. However, the incidence consi stently remained higher in the chronic rejection group. This differenc e reached significance by year 3 after transplantation. Furthermore, a high rate of urinary tract infections correlated with an early onset of chronic rejection. Conclusions: Urinary tract infections are an imp ortant risk factor for the onset of chronic rejection, and early and i ntense treatment is critical.