Prophylaxis of Recurrent Urinary Tract Infection After Renal Transplantation by Cranberry Juice and L-Methionine

• Published in: Transplantation proceedings Vol. 44; no. 10; pp. 3017 - 3021
• Main Authors: Pagonas, N, Hörstrup, J, Schmidt, D, Benz, P, Schindler, R, Reinke, P, van der Giet, M, Zidek, W, Westhoff, T.H
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.12.2012; Elsevier
• Subjects: Adult; Aged; Anti-Infective Agents - adverse effects; Anti-Infective Agents - therapeutic use; Bacterial diseases; Bacterial diseases of the urinary system; Beverages - adverse effects; Biological and medical sciences; Chi-Square Distribution; Female; Fruit; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Germany - epidemiology; Human bacterial diseases; Humans; Incidence; Infectious diseases; Kidney Transplantation - adverse effects; Male; Medical sciences; Methionine - adverse effects; Methionine - therapeutic use; Middle Aged; Plants, Medicinal; Recurrence; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Tissue, organ and graft immunology; Treatment Outcome; Urinary Tract Infections - epidemiology; Urinary Tract Infections - microbiology; Urinary Tract Infections - prevention & control; Vaccinium macrocarpon; Germany; Thiol; Chemoprophylaxis; Relapse; Urinary system disease; Methionine; Urinary tract disease; Recurrent; Homotransplantation; Kidney; Sulfur containing aminoacid; Medicine; Urinary tract infection; Treatment; Urinary system; Surgery; Antiseptic; Graft; Kidney transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.06.071

Abstract Background Recurrent urinary tract infections (UTIs) increase mortality and reduce graft survival after renal transplantation. Strategies to prevent recurrent UTIs include L-methionine, cranberry juice, and antibiotics. Data on the efficacy of cranberry and L-methionine, however, are controversial in the general population; there are few data in renal transplant recipients. Methods We performed a retrospective analysis of 82 transplant recipients with recurrent UTIs, who underwent prophylaxis with cranberry juice (2 × 50 mL/d, n = 39, 47.6%), or L-methionine (3 × 500 mg/d, n = 25, 30.5%), or both modalities ( n = 18, 21.9%). Thirty patients without prophylaxis served as controls. We analyzed symptoms, pyuria/nitrituria, and incidence of UTI events during 1 year before versus after initiation of prophylaxis. Results Prophylaxis highly significantly decreased the annual UTI incidence by 58.3% ( P < .001) in the study population with no change in the control group ( P = .85); in addition, 53.7% of symptomatic patients reported relief of symptoms and pyuria/nitrituria disappeared in 42.4% of the dipstick-positive patients ( P < .001 each). Cranberry reduced the annual number of UTI episodes by 63.9% from 3.6 ± 1.4 to 1.3 ± 1.3/year ( P < .001) and L-methionine by 48.7% from 3.9 ± 1.8 to 2.0 ± 1.3/year ( P < .001). Conclusion Cranberry juice and L-methionine successfully reduced the incidence of UTI after renal transplantation.