Transplantation in Patients Undergoing CAPD

Abstract

Between May 1980 and December 1983, 39 patients on continuous ambulatory peritoneal dialysis (CAPD) received renal allografts, which represents 18% of the 212 transplants done during this period. The remaining 173 allografts were transplanted into 162 patients who to the time of operation had been maintained on hemodialysis. For the CAPD and hemodialysis patients respectively, the one-year graft survival for first cadaveric transplants was 61% and 59%, while, for the two groups, the one-year patient survival was identical-95%. In five of the 14 patients (36%) in whom CAPD was used immediately after the transplant peritonitis developed, but in none of the 25 patients who did not have CAPD at this time. The Tenckhoff catheters were left in situ for a mean period of 12.7 weeks after the transplant without leading directly to any complications. However, at catheter removal, organisms grew on cultures from 11 of 25 catheter tips (44%). In conclusion, graft and patient survival is as high in CAPD patients as in those maintained by hemodialysis. In patients in whom the transplant does not function immediately we now use hemodialysis because CAPD at this time is associated with peritonitis and wound infection in some of the patients. Only a few centres have described their experience with renal transplantation in CAPD patients and most have not considered CAPD to be a contraindica tion to transplantation (1–5). However, based on one case report Cramer et al (6) suggested that CAPD provides a suboptimal preparation for transplantation, and Gelfand et al (7) reported that compared with hemodialysis, patients on CAPD had inferior transplant results. The small numbers of patients and varying selection criteria in most of these studies may explain the differences of opinion. This paper describes our experience with 39 CAPD patients who received renal allografts between May 1980 and Dec. 1983.