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Article
July 1996

Long-term Peritoneal Dialysis Before Transplantation and Intra-abdominal Infection After Simultaneous Pancreas-Kidney Transplantations

Author Affiliations

From the Department of Surgery (Drs Papalois, Troppmann, Benedetti, Sutherland, and R. W. G. Gruessner) and School of Public Health (Dr A. C. Gruessner), University of Minnesota, Minneapolis.

Arch Surg. 1996;131(7):761-766. doi:10.1001/archsurg.1996.01430190083021
Abstract

Objective:  To investigate whether long-term peritoneal dialysis before transplantation entails a higher risk than hemodialysis for intra-abdominal infection after bladder-drained simultaneous pancreas-kidney transplantations.

Design:  Large single-center case-control study.

Setting:  A large university hospital (referral center).

Patients:  In all, 189 bladder-drained simultaneous pancreas-kidney transplantations were done from January 1, 1986, to December 31, 1994: before transplantations were performed, 32 recipients (17%) were undergoing peritoneal dialysis, 71 recipients (38%) were undergoing hemodialysis, and 86 recipients (46) were not undergoing dialysis.

Main Outcome Measures:  The intra-abdominal infection rate after transplantation and the rate of graft loss due to infection.

Results:  Intra-abdominal infections developed in 33 recipients (18%) after transplantation. Graft and patient survival rates were significantly lower for recipients with vs without an infection (P<.001 for both). Both the dialysis mode and dialysis dependence did not affect the infection rate: of the 33 recipients with an infection, 7 (21%) were undergoing peritoneal dialysis, 15 (46%) were undergoing hemodialysis, and 11 (33%) were not undergoing dialysis before transplantation (P=.3). The rate of graft loss due to infection was not significantly different for recipients who were undergoing peritoneal dialysis vs hemodialysis (P=.1). However, it was higher for recipients who were undergoing dialysis (peritoneal dialysis and hemodialysis) vs those patients who were not undergoing dialysis (P=.04).

Conclusions:  Candidates for simultaneous pancreas-kidney transplantation should undergo the transplantation preemptively (ie, before they become dependent on dialysis) because the rate of graft loss due to infection was higher for recipients who were underoing dialysis (irrespective of the dialysis mode). If dialysis cannot be avoided, the choice of peritoneal dialysis vs hemodialysis can be individualized, since these dialysis modes do not have significantly different rates of infection or of graft loss due to infection.Arch Surg. 1996;131:761-766

References
1.
Morel P, Goetz FC, Moudry-Munns KC, Freier EF, Sutherland DER.  Long-term glucose control in patients with pancreatic transplants . Ann Intern Med . 1991; 115:694-699.Article
2.
Gruessner A, Sutherland DER.  Pancreas transplant results in the United Network for Organ Sharing (UNOS) United States of America (USA) registry compared with non-USA data in the international registry . In: Terasaki PI, Cecka JM, eds. Clinical Transplants 1994 . Los Angeles, Calif: UCLA Tissue Typing Laboratory; 1994:47-68.
3.
Troppmann C, Benedetti E, Gruessner AC, et al.  Vascular graft thrombosis after pancreas transplantation: uni- and multivariate surgical and nonsurgical risk factor analysis . J Am Coll Surg . 1996;182:285-316.
4.
Gruessner RWG, Sutherland DER.  Pancreas transplantation, II: the recipient operation . Surg Rounds . 1994;17:383-391.
5.
Gruessner RWG, Troppmann C, Barrou B, et al.  Assessment of donor and recipient risk factors on pancreas transplant outcome . Transplant Proc . 1994; 26:437-438.
6.
Olcott C, Feldman CA, Coplon NS, Oppenheimer ML, Mehigan JT.  Continuous ambulatory peritoneal dialysis: technique of catheter insertion and management of associated surgical complications . Am J Surg . 1983;146:98-102.Article
7.
De Fijter CWH, Verbrugh HA, Oe PL, et al.  The effect of glycerol-containing peritoneal dialysis fluid on peritoneal macrophage function in vivo . Adv Perit Dial . 1991;7:154-157.
8.
De Fijter CWH, Verbrugh HA, Peters EDJ, et al.  Another reason to restrict the use of a hypertonic glucose-based peritoneal dialysis fluid: its impact on peritoneal macrophage function in vivo . Adv Perit Dial . 1991;7:150-153.
9.
Dobbie JW, Lloyd JK, Gall CA.  Categorization of ultrastructural changes in peritoneal mesothelium, stroma, and blood vessels in uremia and CAPD patients . Adv Perit Dial . 1990;6:3-12.
10.
Blake PG, Abraham G, Sombolos K, et al.  Changes in peritoneal membrane transport rates in patients on long-term CAPD . Adv Perit Dial . 1989;5:3-7.
11.
Sutherland DER.  Immunosuppression for clinical pancreas transplantation . Clin Transplant . 1991;5:549-553.
12.
Troppmann C, Dunn DL, Najarian JS, Sutherland DER, Gruessner AC, Gruessner RWG.  Operative reintervention following early complications after pancreas transplantation . Transplant Proc . 1994;26:454.
13.
Troppmann C, Gruessner RWG, Dunn DL, Fasola C, Najarian JS, Sutherland DER.  Is transplant pancreatectomy after graft failure necessary? Transplant Proc . 1994;26:455.
14.
Douzdjian V, Abecassis MM, Cooper JL, Smith JL, Corry RJ.  Incidence, management, and significance of surgical complications after pancreas transplantation . Surg Gynecol Obstet . 1993;177:451-456.
15.
Everett JE, Wahoff DC, Statz C, et al.  Characterization and impact of wound infection after pancreas transplantation . Arch Surg . 1994;129:1310-1317.Article
16.
Haeyry P, von Willebrand E, Taskinen E, Hoeckerstedt K, Ahonen J, Eklund B.  Is uremia immunosuppressive in renal transplantation? Transplantation . 1982; 34:268-272.Article
17.
Brayman KL, Stephanian E, Matas AJ, et al.  Analysis of infectious complications after solid organ transplantation . Arch Surg . 1992;127:38-48.Article
18.
Troppmann C, Gruessner AC, Benedetti E, Papalois BE, Sutherland DER, Gruessner RWG.  Positive duodenal segment cultures are not associated with increased surgical complications after whole organ bladder-drained pancreas transplantation in three different recipient categories . Transplant Proc . 1995;27:3101-3103.
19.
Stratta RJ, Taylor RJ, Ozaki CF, et al.  A comparative analysis of results and morbidity in type I diabetics undergoing preemptive versus postdialysis combined pancreas-kidney transplantation . Transplantation . 1993;55:1097-1103.Article
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