Original investigations: transplantation
Late urinary tract infection after renal transplantation in the United States1

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Abstract

Background: Although urinary tract infection (UTI) occurring late after renal transplantation has been considered “benign,” this has not been confirmed in a national population of renal transplant recipients. Methods: We conducted a retrospective cohort study of 28,942 Medicare primary renal transplant recipients in the United States Renal Data System (USRDS) database from January 1, 1996, through July 31, 2000, assessing Medicare claims for UTI occurring later than 6 months after transplantation based on International Classification of Diseases, 9th Revision (ICD-9), codes and using Cox regression to calculate adjusted hazard ratios (AHRs) for time to death and graft loss (censored for death), respectively. Results: The cumulative incidence of UTI during the first 6 months after renal transplantation was 17% (equivalent for both men and women), and at 3 years was 60% for women and 47% for men (P < 0.001 in Cox regression analysis). Late UTI was significantly associated with an increased risk of subsequent death in Cox regression analysis (P < 0.001; AHR, 2.93; 95% confidence interval [CI], 2.22, 3.85); and AHR for graft loss was 1.85 (95% CI, 1.29, 2.64). The association of UTI with death persisted after adjusting for cardiac and other infectious complications, and regardless of whether UTI was assessed as a composite of outpatient/inpatient claims, primary hospitalized UTI, or solely outpatient UTI. Conclusion: Whether due to a direct effect or as a marker for serious underlying illness, UTI occurring late after renal transplantation, as coded by clinicians in the United States, does not portend a benign outcome.

Section snippets

Patients

Details of the files used for data abstraction for this study, as well as limitations of Medicare claim data, have been described previously and differ by year of selection and limitations of key variables, notably the use of the Centers for Medicare/Medicaid Studies Medical Evidence Form (CMS 2728).12, 13 Files used and merged in analysis were SAF.TXUNOS for the base transplant information, which was merged with SAF.TXFUUNOS for follow-up information, SAF.TXIUNOS for medication information,

Results

Of 59,077 recipients of renal transplants from January 1, 1996, to July 31, 2000, 29,597 had valid follow-up times and evidence of Medicare as primary payer at the time of transplantation. Of these, 28,942 (97.7%) had Medicare payment dates with valid Medicare as primary payer status (by SAF.PAYHIST) within 14 days of transplantation. During the study period, 12,508 (43.2%) had either an inpatient or outpatient claim for UTI (composite UTI); 12,803 recipients (44.3%) had physician supplier

Discussion

In the present study of the USRDS renal transplant population, the novel finding was that UTI occurring late after renal transplantation, regardless of how defined, was independently associated with an increased risk of subsequent recipient death and graft loss. The idea that late UTI after renal transplantation is “benign” derives mainly from 2 relatively small studies.7, 8 Further, recent reports suggest that many patients with late UTI present with advanced infections.10, 11 Because causes

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    The opinions are solely those of the authors and do not represent an endorsement by the Department of Defense or the National Institutes of Health.

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    Copyright © 2004 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.