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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE  
Year : 2021  |  Volume : 32  |  Issue : 2  |  Page : 415-417
Outcomes of removal of peritoneal dialysis catheter at the time of renal transplant


Nottingham Renal and Kidney Transplant Unit, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK

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Date of Web Publication11-Jan-2022
 

   Abstract 


There is no consensus regarding timing of peritoneal dialysis (PD) catheter removal following kidney transplant. We hypothesize that early removal of PD catheter reduces the risk of peritonitis. We conducted a prospective closed-loop audit to review existing practice in our department and determine whether a better strategy could be implemented. Simple descriptive and inferential statistics were used to generate results. Categorical data were described using frequency and percentage. Continuous values were reported as mean ± standard deviation. Between November 2016 and April 2017, forty patients had renal transplant with PD in situ. On average time to removal of PD catheter, posttransplant was 84 days. Four patients (10%) developed exit-site infection. Following departmental consultation, practice was changed to remove all PD catheters at the time of transplant. Between May 2017 and January 2018, twenty patients had renal transplant and 19 had PD catheter removed at the time of transplant. Of these, one required re-insertion. In the patient where PD catheter was left in situ, peritonitis was a complication. We continue to recommend PD catheter removal at the time of transplant.

How to cite this article:
Parks RM, Saedon M. Outcomes of removal of peritoneal dialysis catheter at the time of renal transplant. Saudi J Kidney Dis Transpl 2021;32:415-7

How to cite this URL:
Parks RM, Saedon M. Outcomes of removal of peritoneal dialysis catheter at the time of renal transplant. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 Jun 25];32:415-7. Available from: https://www.sjkdt.org/text.asp?2021/32/2/415/335453



   Introduction Top


Peritoneal dialysis (PD) is an option for renal replacement therapy in patients with end-stage renal disease.[1] Evidence has shown that transplantation offers a clear advantage over PD or hemodialysis (HD) in terms of extending life, however, availability of suitable donor, comorbidities, and ongoing immunosuppression must be considered.[2],[3]

There is no consensus regarding the timing of PD catheter removal following transplant. European Best Practice Guidelines[4] state that PD catheters should not be removed at the time of transplant in case of delayed graft function (DGF) and should be left in situ for three to four months. These guidelines were published in 2005, and the data included now 15–20 years old.

The risk of exit-site infection, peritonitis, and even bowel obstruction[5] in PD patients after renal transplantation is documented and contributed to by immunosuppression and breach of the peritoneum.[6] Rates of peritonitis in this group have been documented to be up to 9%.[7],[8] Current opinion is that this complication can be treated successfully with antibiotics.[6],[9] However, the complications and failure rates are not yet established.

The aim of this prospective quality improvement study was to establish the outcomes of a new policy of removal of PD catheter at the time of transplant in our institution.


   Subjects and Methods Top


Study design

Prospective closed-loop audit approach was used. All subjects who presented for surgery during November 2016 to April 2017 (1st cycle) and May 2017 to January 2018 (2nd cycle) were included on a prospectively maintained database. Retrospective data collection and analysis were performed. A new policy was implemented in our institution in May 2017 stating that all PD catheters should be removed at the time of transplantation.

Inclusion criteria

  • ≥18 years of age
  • Transplanted kidney
  • PD catheter already in situ.


Primary outcome

PD catheter-associated complications.

Secondary outcomes

Time of removal of PD catheter post renal transplant, number of episodes of dialysis posttransplantation, and method.

Data collection

Data collected included date of transplantation, date of removal of PD catheter, cold ischemic time, initial graft function, complications relating to PD catheter, number of episodes of dialysis post-transplantation, and method of dialysis.

Ethics

Research Ethics Committee review was not required under the harmonized Governance arrangements for Research Ethics Committees.


   Results Top


[Table 1] outlines the results for both cycles of the data collection.
Table 1: Comparative results between the 1st and 2nd audit cycle.

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Between November 2016 and April 2017, 40 patients had renal transplant with PD in situ and 20 had transplantation between May 2017 and January 2018. Practice was changed between these two cycles following departmental consultation.

Average time to removal of PD catheter post- transplant in the first cycle was 84 days. Four patients (10%) developed exit-site infection.

During the second cycle, 19 patients had PD catheter removed at the time of transplant. Of these, one required re-insertion. In the patient where PD catheter was left in situ, peritonitis was a complication. There was no statistically significant difference in the rate of complication between the two groups (P = 0.2).


   Discussion Top


Our previous practice was to remove PD catheter when graft function had been established; however, it was clear following the first cycle of results that the definition of established graft function varied between practitioners, and therefore, there was variation in timing of PD catheter removal.

The key aim of the first cycle was to quantify the incidence of PD-related complications. DGF occurred in five cases (12.5%), four of whom required HD. There were four cases of wound infection requiring antibiotics, in the group who had PD catheters left in situ. A decision was made to change practice and remove PD catheter at the time of transplant.

Re-audit of our new practice demonstrated DGF incidence in four cases (25%), one requiring PD catheter to be reinserted. In the one case where PD catheter was left in situ, this patient unfortunately developed peritonitis. There was no significant difference in rate of complication between the two groups, most likely due to small sample sizes used.

To date, there is little in the current literature to compare our findings to. Our first cycle had similar findings to Pampa-Saico et al,[10] who reviewed 112 kidney transplant cases, all of whom were discharged with PD catheter left in situ. Of these, 6% developed exit-site infection and 2% peritonitis. The authors concluded that this complication rate was acceptable.

Our second cycle audit results mirror the results of Warren et al[7] who examined 137 transplant patients with PD catheter, 19 had catheter removed at transplant. In the group who had PD catheter removed, one had DGF and underwent HD. Complications related to leaving PD catheter in situ included peritonitis (8%), exit-site infection (2%), and emergency laparotomy (1%). As a result of this study, the authors conclude that PD catheter removal should be considered at the time of transplantation.

Our study is clearly supporting the removal of PD catheter at the time of kidney transplant. Even though our study is based on a population of patients in a single center, the results were in concordance with recent published data from another center. In our institution, we have continued the policy to remove PD catheters at the time of transplant.

Conflict of interest: None declared.



 
   References Top

1.
Woodrow G, Fan SL, Reid C, Denning J, Pyrah AN. Renal association clinical practice guideline on peritoneal dialysis in adults and children. BMC Nephrol 2017;18:333.  Back to cited text no. 1
    
2.
Sinnakirouchenan R, Holley JL. Peritoneal dialysis versus hemodialysis: Risks, benefits, and access issues. Adv Chronic Kidney Dis 2011;18:428-32.  Back to cited text no. 2
    
3.
Pesavento TE. Kidney transplantation in the context of renal replacement therapy. Clin J Am Soc Nephrol 2009;4:2035-9.  Back to cited text no. 3
    
4.
Dombros N, Dratwa M, Feriani M, et al. European best practice guidelines for peritoneal dialysis. 9 PD and transplantation. Nephrol Dial Transplant 2005;20 Suppl 9: ix34-5.  Back to cited text no. 4
    
5.
Maxted AP, Davies B, Colliver D, Williams A, Lunn A. Peritoneal dialysis catheter removal post-transplant – A rare case of delayed bowel perforation. Perit Dial Int 2017;37:650-1.  Back to cited text no. 5
    
6.
Bakir N, Surachno S, Sluiter WJ, Struijk DG. Peritonitis in peritoneal dialysis patients after renal transplantation. Nephrol Dial Transplant 1998;13:3178-83.  Back to cited text no. 6
    
7.
Warren J, Jones E, Sener A, et al. Should peritoneal dialysis catheters be removed at the time of kidney transplantation? Can Urol Assoc J 2012;6:376-8.  Back to cited text no. 7
    
8.
Rizzi AM, Riutta SD, Peterson JM, et al. Risk of peritoneal dialysis catheter-associated peritonitis following kidney transplant. Clin Transplant 2018;32:e13189.  Back to cited text no. 8
    
9.
Maiorca RS, Cancarini GC, Camerini C, Scolari F, Cristinelli L, Filippini M. Kidney transplantation in peritoneal dialysis patients. Perit Dial Int 1994;14 Suppl 3:S162-8.  Back to cited text no. 9
    
10.
Pampa-Saico S, Caravaca-Fontán F, Burguera- Vion V, et al. Outcomes of peritoneal dialysis catheter left in place after kidney transplantation. Perit Dial Int 2017;37:651-4.  Back to cited text no. 10
    

Top
Correspondence Address:
Ruth M Parks
Nottingham Renal and Kidney Transplant Unit, City Hospital, Nottingham NG5 1PB
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-2442.335453

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    Abstract
   Introduction
   Subjects and Methods
   Results
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