Outcome in patients with end-stage renal disease following heart or heart-lung transplantation receiving peritoneal dialysis

Background. End-stage renal disease (ESRD) complicates 5-10% of heart and h eart-lung transplant patients. We report our experience of peritoneal dialy sis (PD) in 17 such patients. Methods. Between March 1995 and February 1999, 13 heart transplant and four heart-lung transplant patients (11 male, 6 female) joined our PD programme (10 continuous ambulatory PD, seven automated PD). Median time from heart or heart-lung transplantation to ESRD was 9 years (range 1-13 years), and m edian age at introduction of renal replacement therapy was 51 years (range 23-66 years). The frequency of exit-site infections, peritonitis, and PD su rvival (including technique failure and death) in the transplant group (TxP ) was calculated retrospectively. These were compared with two contemporary control groups: PD patients immunosuppressed for other indications (ISP, n = 19) and, all other patients recruited onto the PD programme (NISP, n = 1 32). Results. Median follow-up was 10 months (range 2-27 months) for TxP, 7 mont hs (range 2-29 months) for ISP, and 14 months (range 1-48 months) for NISP groups. The frequency of exit-site infections was similar in each group: 1 in 26 months for TxP; 1 in 30 months for ISP, and 1 in 27 months for NISP ( P=NS). The frequency of peritonitis was greater in the TxP group at 1 in 15 months, compared with 1 in 20 months for ISP and 1 in 29 months for NISP ( TxP rs NISP, P<0.05). PD failure following infection was 23.5% for TxP, 10. 5%, for ISP, and 12.9% for NISP. Actuarial PD survival at 24 months was onl y 25.2% in the TxP group compared with 79% in the NISP group. There were no deaths related to immediate complications of PD. Conclusions. Increased risk of PD peritonitis and reduced PD survival is re ported in this cohort of 17 heart and heart-lung recipients with ESRD. Neve rtheless, for patients with severely impaired cardiac function, PD may stil l offer therapeutic advantage.