Peritoneal dialysis immediately after kidney transplantation

Approximately 10% - 20% of adult kidney transplant recipients and as many as 40% of pediatric recipients receive peritoneal dialysis (PD) before kidney transplantation. An important aspect of perioperative kidney transplant care is management of the PD catheter. Peritoneal dialysis can be performed immediately after transplantation for delayed graft function (DGF), which can occur with as many as 20% of deceased-donor kidney grafts, especially when expanded criteria or organs from donation after cardiac death are used. However, leaving the PD catheter in place has been associated with an increased risk for infections such as peritonitis and exit-site infection, even when the catheter is not used. Although no consensus has been reached about the management of PD catheters after kidney transplantation, transplant centers should have a low threshold for PD catheter removal at the time of surgery, especially in recipients with a low risk for DGF. In individuals with high risk for DGF the PD catheter can be left in place, but it must be removed in a timely manner once it is no longer needed.