Use of Peritoneal Dialysis for Delayed Graft Function After Kidney Transplantation: An International Survey.

BACKGROUND

Use of peritoneal dialysis (PD) for delayed graft function (DGF) and practices surrounding PD catheter removal after kidney transplantation are not well described. We surveyed transplant nephrologists and surgeons to understand approaches to post-transplant dialysis modality use and PD catheter management in individuals receiving PD prior to transplantation.

METHODS

We conducted an international electronic survey of transplant nephrologists and surgeons from adult kidney transplant centers in Australia/New Zealand (n=19), Canada (n=18), Israel (n=6), and the United States (n=235). The survey focused on dialysis modality selection for DGF and PD catheter removal practices.

RESULTS

Ninety-seven physicians (83 nephrologists, 14 surgeons) responded, yielding a center representation rate of 35% (range: 26% in the United States to 100% in Israel). Fifty percent (48/97) of respondents reported retaining the PD catheter for deceased donor transplants only, while 18% (17/97) routinely retain the PD catheter after both deceased and living donor transplants. Among respondents managing patients with DGF who were receiving PD pre-transplant, 38% (37/97) reported using PD immediately after transplantation. Surgeons were significantly less likely than nephrologists to report using PD for DGF (7% vs. 43%). Commonly cited concerns regarding post-transplant PD were non-infectious complications (58%), including dialysate leaks, inadequate clearance or ultrafiltration, followed by concerns regarding infection risk (42%). Logistical considerations, such as the need for additional surgical procedures, also influenced decisions around PD catheter removal.

CONCLUSIONS

PD catheter management and dialysis modality selection after kidney transplantation varied substantially and were driven by concerns regarding complications, perceived dialysis efficacy, and logistics. These findings highlight the need for evidence-based guidance on PD use, and PD catheter management following kidney transplantation.