NG C1,2, BOTROUS M3, MOUNT P1, LEE D1,3, DAVIES M1
1Department of Nephrology, Austin Health, Heidelberg, Australia, 2Department of Renal Medicine, Bendigo Health, Bendigo, Australia, 3Department of Renal Medicine, Eastern Health Clinical School, Box Hill, Australia
Aim: To study the utility of leaving peritoneal dialysis catheters (PDCs) in situ at the time of deceased donor kidney transplantation (DDKT).
Background: PDCs are commonly not removed at the time of DDKT in case of delayed graft function (DGF). Data to justify this approach is lacking.
Methods: Electronic medical records were retrospectively reviewed for peritoneal dialysis (PD) patients receiving DDKT at a single centre (November 2009 to December 2018). Primary outcomes were the proportion of PDCs accessed post-transplant, and PDC-related infections.
Results: 79 PD patients (median age 57, range 20-73) receiving DDKT were identified. Only 2 (2.5%) had PDCs removed at the time of transplantation. 30 (38%) patients experienced DGF. Of those, 4 (13.3%) underwent PD (median duration 2.5 days, range 1-4) with no PD-related complications; 26 (86.7%) underwent haemodialysis (HD). Of those undergoing HD, 14 (53.8%) required central venous catheter insertion; others had pre-existing arteriovenous fistulae (n=11) or tunnelled catheter (n=1). 75/77 (97.4%) patients had PDCs removed at a median time of 79 days (range 4-303). PDCs were not removed in 2 (2.6%) as they resumed chronic PD following graft losses at 88 and 932 days. 4/77 (5.2%) patients with PDCs left in developed exit site infections; 1/77 (1.3%) experienced peritonitis requiring urgent PDC removal. Overall peritonitis rate was 0.05 episodes per patient-year with PDCs in situ.
Conclusions: In this cohort, there was a low rate of PDC use post-DDKT (7.8%), even amongst those with DGF (13.3%). 6.5% of patients developed PDC-related infections. 97.4% of patients required a second operation (PDC removal). The risks of leaving PDCs in situ at the time of DDKT may outweigh the benefits for the majority of patients.
Dr Chau W Ng is a visiting nephrologist at Bendigo Health and post-fellowship general medicine advanced trainee at Austin Health.