Recurrent urinary tract infection in the post-transplant reflux nephropathy patient: Is reflux in the native ureter the culprit?

We assessed the prevalence of symptomatic, refluxing systems as a cause of recurrent urinary tract infection (UTI) in patients who underwent renal transplantation as result of renal failure from reflux nephropathy. Eleven patients from the age of 8 to 19 yr underwent renal transplantation for renal failure because of reflux nephropathy, between 1992 and 2003. Culture documented UTI were investigated and correlated with pre- and postoperative infection rates, voiding dysfunction (VD), concomitant nephrectomy, or nephroureterectomy with refluxing native remnants, and pretransplant ureteral reimplantation. Four patients with nephroureterectomies and no VD were infection free posttransplant. Two of three patients reimplanted pretransplant with a history of VD had one or more UTI per month. Patients with nephrectomies without partial ureterectomies with or without VD also had one or more UTI per month. Refluxing systems in the immunosuppressed transplant patient may play a role in UTI especially when associated with VD. Surgical intervention of native refluxing systems may be warranted.