Reduced incidence of acute renal graft failure in patients treated with peritoneal dialysis compared with hemodialysis

In a case-control study performed in two centers, the incidence of delayed graft function (DGF), defined as the necessity to perform dialysis after tr ansplantation, was analyzed according to prior treatment with continuous am bulatory peritoneal dialysis (CAPD; n = 117) or hemodialysis (HD; n = 117), The patients were matched for age, sex, HLA compatibility, and cold ischem ia time. The patients were followed up for 6 months to monitor renal graft function (serum creatinine [Screa] level immediately after transplantation, at 6 weeks, at 6 months) and postoperative complications. No significant d ifferences were found in the warm ischemia time of the graft or previous ti me on dialysis, DGF occurred in 27 CAPD patients (23.1%) and 59 HD patients (50.4%; P < 0.0001), The decline in Screa level after transplantation was faster in CAPD patients: the time for Screa level to decrease 50% after tra nsplantation (T1/2Screa) was reached after 5.0 +/- 6.6 days in the CAPD gro up compared with 9.8 +/- 11.5 days in the HD group (P < 0.0001), A greater number of patients developed acute rejection episodes in the CAPD group (P < 0.05), but Screa level was not different in the two groups 6 weeks and 6 months after transplantation. No differences were observed in infectious or surgical complications. This study shows that immediate renal function aft er transplantation is better in CAPD patients and that peritoneal dialysis should be considered as a first choice for pretransplantation therapeutic m odality. (C) 1999 by the National Kidney Foundation, Inc.