Peritoneal dialysis catheter removal at the time of renal transplantation: Choosing the optimal candidate

Abstract

Introduction: Concurrent peritoneal dialysis (PD) catheter removal during renal transplantation is controversial, with limited evidence supporting this practice. Our objective was to determine the rate of delayed graft function (DGF) in patients on preoperative PD. Additionally, we sought to identify which patients can safely have their PD catheter removed during transplantation due to a low risk of DGF. Methods: We conducted a retrospective observational study between June 2011 and December 2015. The primary outcome was the diagnosis of DGF, defined as the need for dialysis within the first week of transplantation. Clinical and transplant factors, including graft type and donor criteria, were assessed for association with the primary outcome. Catheter-related complication rates were also compared between post-transplant PD and hemodialysis (HD). Results: Of our cohort of 567 patients, 145 patients (25.6%) developed DGF. Obesity (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.00–1.11; p=0.04) and increased perioperative blood loss (OR 1.002; 95% CI 1.000–1.003; p=0.03) were predictors of DGF. Protective factors included living donor (LD) grafts (OR 0.15; 95% CI 0.05–0.49; p=0.002) and intraoperative graft urine production (OR 0.39; 95% CI 0.23–0.65; p<0.001). In our PD cohort, only LD grafts demonstrated lower DGF rates (0 LD vs. 20.8% deceased donor; p=0.003). In terms of post-transplant renal replacement therapy, patients on PD and HD had similar duration of temporary dialysis (one day PD vs. two days HD; p=0.48) and catheter-related complication rates (4.5% PD vs. 2.6% HD; p=0.30). Conclusions: Carefully selected patients, such as those receiving LD grafts, may benefit from concurrent PD catheter removal.