PERITONEAL-DIALYSIS CATHETER INFECTIONS IN CHILDREN AFTER RENAL-TRANSPLANTATION - CHOOSING THE TIME OF REMOVAL

As a foreign body, the peritoneal dialysis (PD) catheter represents a potential source of infection, particularly for immunosuppressed renal transplant patients. A retrospective study was therefore undertaken t o compare the risks and benefits of our policy of removing PD catheter s at 3 months following renal transplant, which was established to all ow for early re-initiation of dialysis. Between 1984 and 1990, 43 rena l transplants were performed in 35 children who had been receiving mai ntenance PD. During the Ist month post transplantation, the PD cathete r was used in 25 patients (58%) because of acute rejection or primary allograft non-function. Thirty-one patients were eventually discharged with functioning allografts and a PD catheter in place, Of them, 43% developed a catheter-related infection within the next 2 months, a per iod during which PD was not performed. Potential contributing factors included a history of catheter-related infection prior to transplantat ion, use of high-dose methylprednisolone to treat acute rejection, and the type of maintenance immunosuppression prescribed; conversely, the use of prophylactic antibiotics appeared to decrease this risk; This study established the potential need for the catheter during the first few weeks, but because of the infection risk of 43% by 3 months post transplantation, our protocol was revised to include catheter removal at the time of hospital discharge. From 1990 until the end of 1992, an additional 19 PD recipients underwent transplantation. In this group, catheters were used during the Ist month in 6 children (32%). Fifteen patients were discharged with a functioning allograft and only 1 pati ent returned to PD at 12 months post transplant. It is concluded that PD catheters represent an additional source of infection following tra nsplantation and should be removed at the time of hospital discharge, after which the likelihood of use is low,