Peluso G, Incollingo P, Carlomagno N, D'Alessandro V, Tammaro V, Caggiano M, Sandoval Sotelo M L, Rupealta N, Candida M, Mazzoni G, Campanile S, Chiacchio G, Scotti A, Santangelo M L
Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy.
Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy.
Transplant Proc. 2019 Jan-Feb;51(1):160-163. doi: 10.1016/j.transproceed.2018.04.075. Epub 2018 Jun 30.
Patients on peritoneal dialysis treatment represent 15% of the global dialysis population. The major complication of peritoneal dialysis is catheter and peritoneal infection. Peritoneal dialysis patients who receive kidney transplants are at increased risk of infection because of immunosuppressive therapy.
The purpose of this study is to show our ideal timing to remove peritoneal catheter after kidney transplant, which gives adequate security on renal function recovery and reduction of septic risk.
We analyzed the outcomes of 65 patients on peritoneal dialysis who underwent kidney transplant between 2000 and 2016.
In 61 cases there was an immediate graft functional recovery. In 4 cases there was a delayed graft function (DGF), and we performed a hemodialysis with temporary placement of a venous catheter. In all patients we removed peritoneal dialysis catheter 30 to 45 days after transplant. There has been 1 case of catheter infection, which was treated with antibiotic therapy.
Our average time to remove the peritoneal dialysis catheter was shorter than times in previous studies, between the 30th and 45th postoperative day. In the 4 cases in which there has been a DGF, we performed hemodialysis treatment to avoid, in the immediate postoperative period, direct insults to the peritoneum by local dialysis procedures.
Our experience show that the 30th to 45th postoperative day is a good time frame, better yet a good watershed between the safe removal of peritoneal catheter when patients have a stabilized renal function and the possibility of leaving it in situ, to resume peritoneal dialysis in case of persistent DGF.
接受腹膜透析治疗的患者占全球透析人群的15%。腹膜透析的主要并发症是导管和腹膜感染。接受肾移植的腹膜透析患者由于免疫抑制治疗而感染风险增加。
本研究的目的是展示我们在肾移植后拔除腹膜导管的理想时机，这能为肾功能恢复提供足够的保障并降低感染风险。
我们分析了2000年至2016年间65例接受肾移植的腹膜透析患者的治疗结果。
61例患者移植肾立即功能恢复。4例出现移植肾功能延迟恢复（DGF），我们通过临时置入静脉导管进行血液透析。所有患者在移植后30至45天拔除腹膜透析导管。发生1例导管感染，经抗生素治疗。
我们拔除腹膜透析导管的平均时间比以往研究短，在术后第30天至45天之间。在出现DGF的4例患者中，则在术后早期进行血液透析治疗，以避免局部透析操作对腹膜造成直接损伤。
我们的经验表明，术后第30天至45天是一个很好的时间范围，更确切地说是一个良好的分水岭，既可以在患者肾功能稳定时安全拔除腹膜导管，也可以在DGF持续存在时保留导管以恢复腹膜透析。
