Transplant Trial Watch

Systematic Review and Meta-Analysis of Asymptomatic Bacteriuria After Renal Transplantation: Incidence, Risk of Complications and Treatment Outcomes.

Gomez-Ochoa, S. A. and A. Vega-Vera (2019).

Transplant Infectious Disease [record in progress].


Aims
This study aimed to evaluate the benefit of treating asymptomatic bacteriuria (ASB) after kidney transplantation.

Interventions
The Embase, EBSCOHost, PubMed, the Cochrane Central Register of Controlled Trials, SciELO, and LILACS were searched for randomized controlled trials (RCTs), cohort studies, and case-control studies that evaluated the effects of treating asymptomatic bacteriuria after renal transplantation regarding the risk of symptomatic urinary tract infection (UTI) and graft function.

Participants
15 studies were included; eight exploored the primary outcome, comprising 1184 patients and 1667 episodes of bacteriuria. Five studies were used to assess secondary outcomes, yielding a total of 1485 patients. Finally, twelve studies evaluated the ASB incidence after KT, involving a total of 3727 patients.

Outcomes
The primary outcome assessed was if treatment was associated with a lower risk of symptomatic UTI or an improved renal function at the end of the follow-up period. The secondary outcome was the risk of acute graft rejection (AGR).

Follow-up
N/A

CET Conclusions
This is a well-conducted systematic review following PRISMA guidelines with a pre-registered protocol on the PROSPERO system. Multiple databases were searched and data extracted in duplicate for the 15 included studies. Studies were assessed for bias, with most unfortunately being at high risk due their retrospective nature. Funnel plot was used to assess for publication bias and a sensitivity analysis to assess the impact of each individual study on the overall conclusion. The pooled incidence of asymptomatic bacteriuria was 22% in the first month after transplantation (three studies) and 32% in the first year after transplantation (10 studies). In meta-analysis there was no relationship between asymptomatic bacteriuria and allograft rejection. There was also no significant relationship between the development of symptomatic UTI whether asymptomatic bacteriuria was treated or not. Nor did the treatment for asymptomatic or bacteriuria have any relationship to later graft function. This systematic review shows that asymptomatic bacteriuria is common after transplantation, however treatment after the first month from date of transplant does not reduce the rate of UTI or improve renal function.

Trial registration
PROSPERO - CRD42018116561

Funding source
Not reported