Successful Peritoneal Dialysis after Intra-Abdominal Transplantation

Editor:

Adhesions and fibrosis from previous surgeries, infections, and malignancies are relative contraindications to peritoneal dialysis (PD) (1). Extensive abdominal surgical scars may suggest adhesions and/or fibrosis and such patients are often counseled to avoid PD. There are no studies reporting on the success of PD in patients with prior intra-abdominal organ transplants. We report here 2 patients with intra-abdominal transplants and extensive surgical scars, and who have been successfully maintained on PD.

Patient 1 is a 60-year-old Caucasian man who underwent orthotopic liver transplant (OLTx) in 1991 for alcoholic cirrhosis, and then developed end-stage renal disease (ESRD) from cyclosporine nephrotoxicity. Due to transportation difficulty, he wished to attempt PD. At the time of catheter insertion, the patient was noted to have chylous ascites, presumed secondary to thoracic duct ligation at the time of OLTx. He began continuous ambulatory peritoneal dialysis (CAPD) in April 2001. His serial total Kt/V results were as follows: 2.04, 2.11, 2.44, 2.30, and 2.14. He has been on PD for 22 months. His albumin fluctuates between 2.4 and 3.5 g/dL; he continues to have intermittent chylous effluent and has had no episodes of peritonitis.

Patient 2 is a 59-year-old Caucasian woman who underwent a pancreas transplant in 1990 and later developed ESRD due to type I diabetes mellitus, tacrolimus nephrotoxicity, and ischemic cardiomyopathy. After multiple hospitalizations for volume overload, she became refractory to oral diuretics and had progressive kidney disease. CAPD was initiated 14 January 2002. Complications have included hypoalbuminemia (albumin 2.9 – 3.6 g/dL), persistent hypophosphatemia requiring oral supplements, and a peritoneal leak manifested as left-sided abdominal wall and labial swelling. The swelling improved with supine evening exchanges, and she was started on cycler-assisted nocturnal dialysis with a dry day (NPD). The patient also developed small abdominal-wall and umbilical hernias; both have remained stable on NPD. Her total Kt/V measurements were 3.91, 4.08, and 2.70 during her 13 months of PD, all with significant residual function.

In total, 35 months of successful PD have been accomplished by these 2 patients. Significant PD complications, including hernia, peritoneal leak, chyloperitoneum, and hypoalbuminemia, have been experienced by our patients. Despite chronic immunosuppression, they have not had frequent infections. Based upon our experience with these 2 patients, we do not consider prior intra-abdominal transplantation an absolute contraindication to PD and would recommend this approach to others.