Nephrology Dialysis Transplantation, Vol 13, Issue 2 430-433, Copyright © 1998 by Oxford University Press
M Sharifian, L Rees and R Trompeter
Background. Bacteriuria is common post-transplant.
However, most studies are in adults with a short follow-up. We have
assessed the incidence of bacteriuria, predisposing causes and its effect
on short and long-term graft function in children. Methods.
The notes of 142 children (67% male) who received 168 kidney
transplants (138 cadaveric) between 1987 and 1994 were studied. The mean
age at transplantation was 9.0±4.5 years, and 32 children were
transplanted pre-emptively. Diagnoses reflected those found in any
children's renal failure programme. Results. Two
hundred and thirty one episodes of bacteriuria were detected in 66 patients
(46%): a rate of one episode per 23 patient months of follow-up. Fifty two
per cent were during the first year, and 29% of these during the first 4
weeks post-transplant. Forty two children (28%) had recurrences. The
incidence was not affected by sex, vesico-ureteric reflux into native
kidneys, donor source, circumcision in boys, dialysis pre-transplant or
acute rejection. Bacteriuria was significantly more common in patients with
a history of bacteriuria before transplant
(P<0.005) and with bladder pathology
(P<0.001). Organisms were predominantly
coliforms (41%); 70% were Gram-negative. Sixty percent were resistant to
the prescribed antibiotic prophylaxis. There was an associated transient
rise in plasma creatinine concentration: mean pre-episode 111±86
&mgr;mol/l vs mean post-episode 134±108
&mgr;mol/l (P<0.0001). Seventy two percent
of episodes were asymptomatic, but even in this group 81% had an associated
rise in plasma creatinine (P<0.001). Despite
this, there was no significant decrease in glomerular filtration rate in
patients with bacteriuria compared with patients without at the end of
follow-up: 50 vs 56 ml/min/1.73
m2 respectively. Conclusion.
Bacteriuria is common post-transplant, occurring most often in
those with bladder pathology or with a history of bacteriuria
pre-transplant. Keywords: bacteriuria; children;
post-transplant
ORIGINAL ARTICLES
High incidence of bacteriuria following renal transplantation in children
Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK; Corresponding author address: Consultant Paediatric Nephrologist, Department of Nephrology, The Hospital for Sick Children, Great Ormond Street NHS Trust, London WC1N 3JH, UK
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