Peritonitis in peritoneal dialysis patients after renal transplantation

Background. The occurrence of peritonitis in peritoneal dialysis patients a fter renal transplantation during immunosuppression might increase morbidit y and mortality. Hence the timing of catheter removal is still controversia l. The associated risk factors of this complication have not been analyzed. Methods. We analyzed, retrospectively, the incidence of peritonitis within 90 days after transplantation, its associated morbidity and mortality, as w ell as risk factors. From 1980 until March 1995, 238 consecutive kidney tra nsplants in peritoneal dialysis patients were performed. Univariate and mul tivariated logistic regression analysis were used to identify risk factors for the development of peritonitis. Results. 232 cases (141 men, 91 women) were available for analysis. In 191 patients, the catheter was removed with a mean interval after transplantati on of 122 days (range 0-573). Thirty peritonitis episodes with predominantl y Staphylococcus aureus (10/30) or Gramnegative bacteria (12/30) were obser ved. Independent risk factors before transplantation were the total number of peritonitis episodes (P < 10(-5)), previous peritonitis with S.aureus ba cteria (P < 10(-5)), and male sex (P < 0.004). Risk factors after transplan tation were technical surgical problems (P < 10(-5)), more than two rejecti on episodes (P < 0.02), permanent graft nonfunction (P < 0.026), and urinar y leakage (P < 0.035). Conclusions. Transplantation without simultaneous peritoneal catheter remov al is feasible. However, this increases the risk of peritonitis after trans plantation. Early catheter removal should be considered seriously in those patients at risk. When peritonitis develops, antibiotic treatment should be directed against Grampositive as well as Gram-negative bacteria until cult ure results are available.