Renal Transplantation in Children Undergoing Peritoneal Dialysis

Between January 1980 and January 1986, 25 children undergoing peritoneal dialysis (CAPD or CCPD) received 29 renal allografts. Patient survival was 100% and graft survival at 12 and at 24 months was similar to that of transplant recipients who received hemodialysis or no dialysis before operation. In 28 of 29 cases, Tenckhoff catheters were left in situ. Eighteen children were treated for acute rejection while retaining their catheters. Fourteen patients required post -transplant dialysis using the in situ catheter because of rejection or cyclosporine nephrotoxicity. No child developed peritonitis during post-transplant CAPD or while being treated for rejection. Peritonitis developed in one child who had a catheter in situ but who did not require dialysis. We conclude that peritoneal dialysis does not incur unacceptable risks to pediatric transplant recipients. During operation, the dialysis catheter may be left in situ and, if necessary, it may be used for CAPD in the post -transplant period.

Renal transplantation in peritoneal dialysis patients has not been extensively described in children. One report by Stefanidis et al (1) in children and others in the adult population (2–5) found acceptable results among such patients. However, several centers have reported an increased risk of complications after transplantation. including a high incidence of infection (6–8) and inferior allograft survival when compared to hemodialysis patients (9).

The issue is important in children because both continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) have become the major forms of renal replacement in many pediatric programs (10–16) including our own. Moreover, since it has been reported that peritonitis is seen with increased frequency among children on peritoneal dialysis (17), we might expect immunosuppression in this group to result in an increased number of infections. This paper describes our experience with children, who received a renal allograft, after undergoing peritoneal dialysis.