Increased incidence of postoperative infections associated with peritonealdialysis in renal transplant recipients

Background, Infection is a frequent postoperative complication in renal tra nsplant recipients, However, little information is available concerning the effect of pretransplantation dialysis modality on posttransplantation comp lications including infection, We therefore evaluated the effect of hemodia lysis (HD) versus peritoneal dialysis (PD) on the incidence of postoperativ e infection as well as several other posttransplantation outcomes. Methods. A retrospective analysis was performed using medical records cover ing the period 30 days after transplantation of 156 dialysis patients who u nderwent renal transplantation at a single center during a 22-month period, Of these patients, 103 received only HD, 32 received only PD, 13 received PD in the past and HD immediately before transplantation (PH/HD), and 8 rec eived HD in the past and PD immediately before transplantation (HD/PD), The presence of culture-proven infection, types of infecting organisms, length of initial hospital stay, and incidence of rejection during the first 30 d ays after transplantation were determined for each patient. Results. All groups were similar with regard to age, race, gender, underlyi ng disease, donor type, incidence of delayed graft function, and perioperat ive antibiotic prophylaxis, There were more infectious complications within 30 days after transplantation in patients on PD just prior to transplantat ion (PD and HD/PD) than in HD patients (67.5% vs. 25,9%, P<0,00001). When t ypes of infectious organisms were assessed, PD patients were found to have a greater incidence of infections with microorganisms that colonize human s kin (P<0,0001). The median length of hospital stay was 3 days longer for PD patients and 6.5 days longer for HD/PD patients than for patients receivin g HD (P=0,01 and 0,04), and PD and HD/PD patients were more likely to have an episode of rejection than HD patients (P=0,02). Conclusions. Renal replacement therapy with PD immediately before transplan tation negatively affects outcome as compared with HD, predisposing patient s to a greater incidence of postoperative infections and rejection and a lo nger hospital stay. Further study in a randomized controlled trial may help determine how adjustment of the dialysis method can optimize transplantati on outcome.