Renal Transplantation in Patients on Peritoneal Dialysis

Abstract

The authors reviewed the course of 56 peritoneal dialysis patients after renal transplantation to determine the influence of this mode of dialysis on the results of transplantation.

Three subgroups were analyzed separately because of marked differences in results. Group 1 was a historical group of 13 diabetic and two nondiabetic recipients of cadaveric grafts transplanted before 1982 who received standard immunosuppression with steroids and azathioprine only, and antirejection therapy with steroids and/or antithymocytic globulin (ATG). In this group results were poor: only 100/o of grafts and 670/o of patients survived two years or more. Group 2, the current group of cadaveric recipients, consists of 11 diabetic and nine nondiabetic patients transplanted since 1982; these patients received standard immunosuppression with low-dose steroids, azathioprine, and a two-week course of prophylactic ATG beginning within one day of transplantation; rejection was treated with high doses of oral steroids. In this second group, results were good: 630/o of the grafts are functioning and 100% of patients have survived for up to two years. Group 3, consisting of 21 recipients of living donor kidneys, had excellent results with 1000/o graft and patient survival up to five years.

Rejection (N = 11), death (N = 5) and renovascular problems (N = 3) caused the 19 graft losses. In most patients the dialysis catheters were removed three weeks to three months after transplantation when renal function was stable. There were two minor complications and no infections related to the catheters.

We conclude that: a) excellent transplant results can be achieved in peritoneal dialysis patients, most of whom are diabetic and receive cadaveric grafts, b) the peritoneal dialysis catheter is not a significant source of peritransplant morbidity and therefore c) peritoneal dialysis is appropriate for patients awaiting renal transplantation and should not bias against their selection for transplantation.

The published literature on kidney transplantation in patients on peritoneal dialysis is sparse, suggesting that it is not, and perhaps should not be common practice to transplant these patients. This study and review of the literature was undertaken 1) to characterize peritoneal dialysis patients undergoing renal transplantation at our center, 2) to determine the results of transplantation in this group, 3) to evaluate the risk to these patients from the peritoneal dialysis catheter itself and 4) to compare our experience with the literature concerning renal transplantation of peritoneal dialysis patients.