Long-term peritoneal dialysis before transplantation and intra-abdominal infection after simultaneous pancreas-kidney transplantations.

OBJECTIVE To investigate whether long-term peritoneal dialysis before transplantation entails a higher risk than hemodialysis for intra-abdominal infection after bladder-drained simultaneous pancreas-kidney transplantations. DESIGN Large single-center case-control study. SETTING A large university hospital (referral center). PATIENTS In all, 189 bladder-drained simultaneous pancreas-kidney transplantations were done from January 1, 1986, to December 31, 1994: before transplantations were performed, 32 recipients (17%) were undergoing peritoneal dialysis, 71 recipients (38%) were undergoing hemodialysis, and 86 recipients (46) were not undergoing dialysis. MAIN OUTCOME MEASURES The intra-abdominal infection rate after transplantation and the rate of graft loss due to infection. RESULTS Intra-abdominal infections developed in 33 recipients (18%) after transplantation. Graft and patient survival rates were significantly lower for recipients with vs without an infection (P < .001 for both). Both the dialysis mode and dialysis dependence did not affect the infection rate: of the 33 recipients with an infection, 7 (21%) were undergoing peritoneal dialysis, 15 (46%) were undergoing hemodialysis, and 11 (33%) were not undergoing dialysis before transplantation (P = .3). The rate of graft loss due to infection was not significantly different for recipients who were undergoing peritoneal dialysis vs hemodialysis (P = .1). However, it was higher for recipients who were undergoing dialysis (peritoneal dialysis and hemodialysis) vs those patients who were not undergoing dialysis (P = .04). CONCLUSIONS Candidates for simultaneous pancreas-kidney transplantation should undergo the transplantation preemptively (ie, before they become dependent on dialysis) because the rate of graft loss due to infection was higher for recipients who were undergoing dialysis (irrespective of the dialysis mode). If dialysis cannot be avoided, the choice of peritoneal dialysis vs hemodialysis can be individualized, since these dialysis modes do not have significantly different rates of infection or of graft loss due to infection.

[1]  D. Dunn,et al.  Vascular graft thrombosis after pancreatic transplantation: univariate and multivariate operative and nonoperative risk factor analysis. , 1996, Journal of the American College of Surgeons.

[2]  D. Sutherland,et al.  Positive duodenal segment cultures are not associated with increased surgical complications after whole organ, bladder-drained pancreas transplantation in three recipient categories. , 1995, Transplantation proceedings.

[3]  D. Dunn,et al.  Characterization and impact of wound infection after pancreas transplantation. , 1994, Archives of surgery.

[4]  D. Dunn,et al.  Assessment of donor and recipient risk factors on pancreas transplant outcome. , 1994, Transplantation proceedings.

[5]  D. Dunn,et al.  Operative reintervention following early complications after pancreas transplantation. , 1994, Transplantation Proceedings.

[6]  D. Dunn,et al.  Is transplant pancreatectomy after graft failure necessary? , 1994, Transplantation proceedings.

[7]  D. Sutherland,et al.  Pancreas transplant results in the United Network for Organ Sharing (UNOS) United States of America (USA) Registry compared with non-USA data in the International Registry. , 1994, Clinical transplants.

[8]  W. Duckworth,et al.  A comparative analysis of results and morbidity in type I diabetics undergoing preemptive versus postdialysis combined pancreas-kidney transplantation. , 1993, Transplantation.

[9]  M. Abecassis,et al.  Incidence, management and significance of surgical complications after pancreatic transplantation. , 1993, Surgery, gynecology & obstetrics.

[10]  D. Dunn,et al.  Analysis of infectious complications occurring after solid-organ transplantation. , 1992, Archives of surgery.

[11]  P. Morel,et al.  Long-term glucose control in patients with pancreatic transplants. , 1991, Annals of internal medicine.

[12]  D. Sutherland.  Immunosuppression for clinical pancreas transplantation , 1991 .

[13]  A. Donker,et al.  The effect of glycerol-containing peritoneal dialysis fluid on peritoneal macrophage function in vivo. , 1991, Advances in peritoneal dialysis. Conference on Peritoneal Dialysis.

[14]  A. Donker,et al.  Another reason to restrict the use of a hypertonic, glucose-based peritoneal dialysis fluid: its impact on peritoneal macrophage function in vivo. , 1991, Advances in peritoneal dialysis. Conference on Peritoneal Dialysis.

[15]  Lloyd Jk,et al.  Categorization of ultrastructural changes in peritoneal mesothelium, stroma and blood vessels in uremia and CAPD patients. , 1990 .

[16]  P. Blake,et al.  Changes in peritoneal membrane transport rates in patients on long term CAPD. , 1989, Advances in peritoneal dialysis. Conference on Peritoneal Dialysis.

[17]  N. Coplon,et al.  Continuous ambulatory peritoneal dialysis. Technique of catheter insertion and management of associated surgical complications. , 1983, American journal of surgery.

[18]  E. Taskinen,et al.  Is uremia immunosuppressive in renal transplantation? , 1982, Transplantation.