Korean Journal of Nephrology 1991;10(4):574-583.

신이식후 요로감염에 대한 임상적 고찰

최영식 , 김수방 , 최환준 , 이병준 , 이신호 , 양상호 , 박상은 , 이시래

Abstract

Among 187 cases of kidney transplantation performed by Kosin Medical College kidney transplantation team from December 1984 to March 1990, we reviewed uri- nary tract infections of 180 cases whose grafted kidney had been functioning for at least 1 month. Foley cath- eter was almost always removed on the 7th post opera- tive day. For prophylaxis cefoperazone was given 1 g twice a day for 7 days from the day of operation and was given twice a day 160 TMP/800 SMZ for 3 months after discontinuation of cefoperazone. We defined UTI as bacteria or fungi were cultured with concentration of at least 100,000 organisms/ml. Of urine. 1) The mean age of patients was 34.4 years and male to female ratio was 2.2:l. 2) The overall incidence of UTI was 22.8% and the total episodes of UTI was 61 with 93.7% occurring during the first three post-transplant months. 3) Patients over 50 years of age had more common UTI with incidence of 60.0% vs. 20.5% in patients below 50 years. In males 16.9% had at least one episode and 4. 8% two or more episodes, while 35.7% and 17.8% in females respectively (p<0.05). 4) There were no significant differences among HLA-ID, HLA-HID, HLA-NID and LUR groups, and no significant difference between CsA treated and Aza treated patients in HLA-HID group. 5) UTI occurred in 100% of patients with chronic pyelonephritis and diabetic nephropathy, and 50% of patients with reflux nephropathy. Grades of vesicour- eteral reflux of original urinary tract did not affect incidence of UTI except grade IV patients with inci- dence of 100%. 6) The bacteria were isolated in 81.8% of UTI. They were E.coli and pseudomonas each 11.7%, S.faecalis and acinetobacter each 7.8%, citrobacter and klebsiella each 5.2F p. The fungi were cultured in 18.2% of UTI. 7) Acute rejections were observed in 46.3% of UTI patients and 28.7% of non-UTI patients(p>0.05). First and third year graft survival rates were 94.7 and 82.9% in UTI patients, 96.3 and 90.9%.' in non-UTI patients (p > 0.05). 8) After ketoconazole was given 200 mg twice a day for 7 days, CsA level increased from 200.0 ng/ml to 578. 0 ng/ml despite 1 mg/kg decrement of CsA(p <0.05).