P112
AUDIT ON UROLOGICAL COMPLICATIONS OF RENAL TRANSPLANTATION
AND THEIR ASSOCIATION WITH BK VIRUS INFECTIONS. ARE THERE AREAS
FOR IMPROVEMENT?
Foteinopoulou, E, Oppong, P, Rowe, P
Renal Unit, Derriford Hospital, Plymouth
INTRODUCTION: Urological complications following renal transplantation are common and
can have a serious impact on graft function and survival. Early recognition of complications is
essential to enable prompt intervention in order to improve patients’ quality of life and prevent
graft loss. There is an increasing body of evidence that BK virus (BKV) infection and
nephropathy in renal recipients are associated with ureteric stricturing and graft loss. Early
detection of BKV infections is associated with better outcomes on graft function.
OBJECTIVES: The aim of the audit was to evaluate the incidence of urological complications,
the time interval to development, the association with the primary disease and potential areas of
improvement. The study also aimed to establish the association between BKV infections and
urological complications and whether appropriate screening had been carried out according to
British Renal Association guidelines.
METHODS: Retrospective review of electronic records from 65 patients, who underwent renal
transplantation at a tertiary transplant centre during a twelve month period. Data was derived
form discharge summaries and outpatient clinic letters. Patients with urological complications
were identified.
RESULTS: 48% of patients were complicated by Urinary Tract Infections (UTIs), 10% by
hydronephrosis and 3% by urine leak. Pathogens isolated in patients with UTIs were
Enterococcus (32%), E.Coli (26%), Coliforms (10%), Extended Spectrum Beta-Lactamases
(10%), Coagulase negative staphylococci (10%) and Candida species (6%). 81% of patients
with UTIs developed symptoms within a month of transplantation. BKV status in those patients
was not assessed. 7 patients (10%) were complicated by hydronephrosis and 4 of those
developed it within the first month. BKV was tested only in 2 of those patients and was found to
be positive in one. 2 patients (3%) had urine leak with one of them manifesting it within the first
month. BKV status was positive in one of those patients while it was not tested in the other.
There was no obvious correlation between primary disease and complication rate.
DISCUSSION: The overall incidence of urological complications in our centre was 13.8%
which compares favourably to 2.9-21% reported in large series. 80% of complications occurred
within the first 4 weeks of transplantation. Enterococcus and E.Coli were the most common
pathogens for UTIs. BKV was tested in only 33% of patients with significant urological
complications (hydronephrosis and urine leak). In 66% of those tested BKV status was positive.
The BRA guidelines suggest routine BKV testing in all transplant patients. Strict
implementation of the guidelines should be routine practice. This might help identify early
patients at risk of developing complications.