Prophylaxis of Recurrent Urinary Tract Infection After Renal
Transplantation by Cranberry Juice and L-Methionine
N. Pagonas, J. Hörstrup, D. Schmidt, P. Benz, R. Schindler, P. Reinke, M. van der Giet,
W. Zidek, and T.H. Westhoff
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.
U
RINARY TRACT INFECTION (UTI) is the most
common infection after renal transplantation ac-
counting for almost 50% of all infectious complications.
1,2
The incidence is highest in the first year following trans-
plantation, but several patients suffer from recurrent UTIs
thereafter. UTIs may have a deleterious impact on both
patient and graft survivals. Seven percent of all UTIs after
renal transplantation lead to septicemia and 60% of septi-
cemia cases in renal transplant recipients are due to UTIs.
3
Moreover, recurrent UTIs may contribute to chronic allo-
graft nephropathy.
4
For a long time, UTIs occurring after 6
months following transplantation have been regarded as
rather benign. Recently, however, a large registry analysis
revealed that late UTIs were significantly associated with an
almost three times increased risk of subsequent death and
an 85% increase in graft loss.
5
Recurrent UTIs necessitate a search for an anatomic
disorder such as vesicoureteral reflux, ureterovesical junc-
tion stricture, prostatic obstruction, or a neurogenic blad-
der. If no anatomic reason is found, medical prophylaxis
may be initiated; however, there are only sparse data on
prophylaxis of recurrent UTI in renal transplant recipients.
There is only limited evidence for antibiotics few experi-
enced with nonantibiotic strategies. Studies published more
than 15 years ago revealed that antibiotic prophylaxis with
trimethoprim-sulfamethoxazole (TMP-SMX) reduced the
From the Department of Nephrology, Charité–Campus Benja-
min Franklin (N.P., P.B., M.v.d.G., W.Z., T.H.W.) and Department
of Nephrology, Charité–Campus Virchow Klinikum (J.H., D.S.,
R.S., P.R.), Berlin, Germany.
N.P. and J.H. contributed equally to the work.
Address reprint requests to Priv Doz Dr Med Timm H.
Westhoff, Charité–Campus Benjamin Franklin, Department of
Nephrology, Hindenburgdamm 30, 12200 Berlin, Germany. E-
mail: timm.westhoff@charite.de
© 2012 by Elsevier Inc. All rights reserved. 0041-1345/–see front matter
360 Park Avenue South, New York, NY 10010-1710 http://dx.doi.org/10.1016/j.transproceed.2012.06.071
Transplantation Proceedings, 44, 3017–3021 (2012) 3017