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REVIEWS AND ORIGINAL ARTICLES |
From the University of Wisconsin Medical School, Clinical Health Sciences Center, Room H4/366, 600 Highland Ave., Madison, WI 53792.
The authors reviewed the course of 56 peritoneal dialysis patients after
renal transplantation to determine the influence of this mode of dialysis on
the results of transplantation.
Three subgroups were analyzed separately because of marked differences in
results. Group 1 was a historical group of 13 diabetic and two nondiabetic
recipients of cadaveric grafts transplanted before 1982 who received standard
immunosuppression with steroids and azathioprine only, and antirejection
therapy with steroids and/or antithymocytic globulin (ATG). In this group
results were poor: only 100/o of grafts and 670/o of
patients survived two years or more. Group 2, the current group of cadaveric
recipients, consists of 11 diabetic and nine nondiabetic patients transplanted
since 1982; these patients received standard immunosuppression with low-dose
steroids, azathioprine, and a two-week course of prophylactic ATG beginning
within one day of transplantation; rejec tion was treated with high doses of
oral steroids. In this second group, results were good: 630/o of the
grafts are functioning and 100% of patients have survived for up to two years.
Group 3, consisting of 21 recipients of living donor kidneys, had excellent
results with 1000/o graft and patient survival up to five years.
Rejection (N = 11), death (N = 5) and renovascular problems (N = 3) caused
the 19 graft losses. In most patients the dialysis catheters were removed
three weeks to three months after transplantation when renal function was
stable. There were two minor complications and no infections related to the
catheters.
We conclude that: a) excellent transplant results can be achieved in
peritoneal dialysis patients, most of whom are diabetic and receive cadaveric
grafts, b) the peritoneal dialysis catheter is not a significant source of
peritransplant morbidity and therefore c) peritoneal dialysis is appropriate
for patients awaiting renal transplantation and should not bias against their
selection for transplantation.
KEY WORDS: Kidney transplantation; peritoneal dialysis; complications of peritoneal dialysis catheter.
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