#1245 Standard or personalized policy of peritoneal catheter removal at kidney transplantation?
Authors: Braga Beatriz Gil , Leitão e Sousa Sofia , Cunha Ana Cristina Santos , Carvalho Maria João , Rodrigues Anabela , Tavares Joana 
Published: May 2024

Abstract

Background and Aims
The presence of peritoneal dialysis (PD) catheter in an immunosuppressed kidney transplant recipient can increment the risk of infectious complications after transplant. For this reason, it is thought that management of PD catheters at the time of transplant can have an impact on patient and graft outcomes. However, there is no agreement when to remove peritoneal dialysis catheter after transplantation. According to European Guidelines, the catheter can be left in situ for 3-4 months despite a functional graft. Our aim was to review the data from our center regarding infectious PD associated complications after kidney transplant.

Method
We retrospectively reviewed all 132 patients that were previously on PD and were admitted to our center for renal transplantation between January of 2013 and June of 2023, and had information regarding timing of removal of PD access. Simple descriptive and inferential statistics were used to generate results. Categorical data were described using frequency and percentage. Our main outcome was to assess the PD infectious catheter-associated complications. Our secondary outcomes were the timing of removal of PD catheter after renal transplantation, number of episodes of dialysis post transplantation, and kidney replacement therapy (KRT) used. Our follow up included the time from kidney transplantation (KT) until they removed PD catheter. Those who removed PD catheter at the timing of renal transplantation were excluded when evaluating the infectious complications.

Results
From the 132 kidney transplant recipients eight patients removed PD catheter at the time of the transplant due to ongoing PD associated infection. Sixty-nine patients were men (52.3%), with a median (IQR) age at transplantation of 48.4 years (41-57). Regarding donors’ characteristics, 88 (33.3%) were deceased, 21 of which were expanded criteria donors, and 44 (66.7%) were living donors. A total of 19 (14.4%) patients had history of PD infectious complications in the three months before transplantation.
From the 124 patients that remained with the PD catheter after KT the adverse event infection occurred in 19 (15.3%) patients and two of these had previous access related infection in the 3 months interval before transplantation. The adverse events were: exit-site infection (ESI) 10.4% (n = 19), peritonitis 3% (n = 4) and tunnel infection 1.6% (n = 2). Half required hospitalization mainly due to center logistics for catheter removal. No deaths were registered. The identified microorganisms are present in Table 1.
The median (IQR) time of removal of the PD catheter was 4 (3-5) months.
Sixteen patients (12.9%) required KRT due to delayed graft function: ten patients used the Tenckhoff catheter and the rest performed haemodialysis (four using central venous catheter and two using arteriovenous fistula). Three patients remained dialysis dependent. When analysing the living donor group the rate of KRT was even lower, with three (6.8%) patients requiring dialysis, and only one used the PD catheter.

Conclusion
Despite the timing of PD catheter removal was according to the European Guidelines, the risk of PD catheter associated infections is not negligible (15.3%), not to mention the burden for the patient to keep an abdominal device demanding routinely care of the exit site. Peritonitis rate was low and comparable to previous studies.
Considering the utility of remaining with the catheter, the risk of needing KRT, namely in living donor KT, was low. We postulate whether PD catheter removal at the time of KT should be considered, especially when the risk of late graft function is low, as in living donors, and/or the risk of PD catheter related infections is high. For this reason, we call for an individualized policy regarding catheter removal in the transition to KT.