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Tanriover C, Copur S, Basile C, Ucku D, Kanbay M. Dialysis after kidney transplant failure: how to deal with this daunting task? J Nephrol 2023; 36:1777-1787. [PMID: 37676635 DOI: 10.1007/s40620-023-01758-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/06/2023] [Indexed: 09/08/2023]
Abstract
The best treatment for patients with end-stage kidney disease is kidney transplantation, which, if successful provides both a reduction in mortality and a better quality of life compared to dialysis. Although there has been significant improvement in short-term outcomes after kidney transplantation, long-term graft survival still remains insufficient. As a result, there has been an increase in the number of individuals who need dialysis again after kidney transplant failure, and increasingly contribute to kidney transplant waiting lists. Starting dialysis after graft failure is a difficult task not only for the patients, but also for the nephrologists and the care team. Furthermore, recommendations for management of dialysis after kidney graft loss are lacking. Aim of this narrative review is to provide a perspective on the role of dialysis in the management of patients with failed kidney allograft. Although numerous studies have reported higher mortality in patients undergoing dialysis following kidney allograft failure, reports are contrasting. A patient-centered, individualized approach should drive the choices of initiating dialysis, dialysis modality, maintenance of immunosuppressive drugs and vascular access.
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Affiliation(s)
- Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Via Battisti 192, 74121, Taranto, Italy.
| | - Duygu Ucku
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
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Peritoneal dialysis catheter removal at the time or after kidney transplantation: a systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:2651-2662. [PMID: 35945300 PMCID: PMC9640428 DOI: 10.1007/s00423-022-02637-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/31/2022] [Indexed: 11/24/2022]
Abstract
Purpose An increasing number of patients treated with peritoneal dialysis eventually undergo kidney transplantation. Owing to opposing reports, we aimed to find evidence about the best time for peritoneal dialysis catheter removal in transplant patients. Methods We conducted a systematic review and random effects meta-analysis of non-randomized studies of intervention comparing patients with peritoneal dialysis catheters left in place or removed during kidney transplantation in regard to the need for dialysis and occurrence of catheter-related complications. We searched (last update on 8 December 2021) PubMed, Embase, Scopus, and Web of Science for eligible studies. ROBINS-I tool and funnel plot asymmetry analysis were used to assess the quality of included articles. Results Eight observational studies were evaluated. Five of them, which involved 338 patients, were included in a meta-analysis. All were at moderate to serious risk of bias. The odds of needing dialysis are more than twice as high for patients with peritoneal dialysis catheters left in situ (pooled odds ratio, 2.21; 95% confidence interval [CI], 1.03 to 4.73; I2 = 0%). No statistically significant difference was noted when adult and pediatric subgroups were compared (Q = 0.13, P = .720). More individuals with catheters left in place required dialysis (pooled prevalence, 20.9%; 95% CI, 13.6 to 30.7%; I2 = 59% vs. 12.4%; 95% CI, 5.6 to 25.2%; I2 = 0%) and experienced catheter-related infections. Conclusion Available evidence is scarce. Unless new data from a randomized controlled trial are available, the dilemma of peritoneal dialysis catheter removal cannot be solved. Trial registration PROSPERO Protocol ID: CRD42020207707. Graphical abstract ![]()
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Gardezi AI, Aziz F, Parajuli S. The Role of Peritoneal Dialysis in Different Phases of Kidney Transplantation. KIDNEY360 2022; 3:779-787. [PMID: 35721606 PMCID: PMC9136899 DOI: 10.34067/kid.0000482022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/23/2022] [Indexed: 04/28/2023]
Abstract
The utilization of peritoneal dialysis (PD) has been increasing in the past decade owing to various government initiatives and recognition of benefits such as better preservation of residual renal function, quality of life, and lower cost. The Advancing American Kidney Health initiative aims to increase the utilization of home therapies such as PD and kidney transplantation to treat end stage kidney disease (ESKD). A natural consequence of this development is that more patients will receive PD, and many will eventually undergo kidney transplantation. Therefore, it is important to understand the effect of pretransplant PD on posttransplant outcomes such as delayed graft function (DGF), rejection, thrombosis, graft, and patient survival. Furthermore, some of these patients may develop DGF, which raises the question of the utility of PD during DGF and its risks. Although transplant is the best renal replacement therapy option, it is not everlasting, and many transplant recipients must go on dialysis after allograft failure. Can PD be a good option for these patients? This is another critical question. Furthermore, a significant proportion of nonrenal solid organ transplant recipients develop ESKD. Is PD feasible in this group? In this review, we try to address all of these questions in the light of available evidence.
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Affiliation(s)
- Ali I. Gardezi
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Gardezi AI, Muth B, Ghaffar A, Aziz F, Garg N, Mohamed M, Foley D, Kaufman D, Djamali A, Mandelbrot D, Parajuli S. Continuation of Peritoneal Dialysis in Adult Kidney Transplant Recipients With Delayed Graft Function. Kidney Int Rep 2021; 6:1634-1641. [PMID: 34169204 PMCID: PMC8207463 DOI: 10.1016/j.ekir.2021.03.899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/11/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Peritoneal dialysis (PD) has been used increasingly in past decade. Many of these patients undergo transplantation and may require dialysis for delayed graft function (DGF). The outcomes of DGF based on the post-transplantation dialysis modality are not well known. METHODS We retrospectively reviewed all adult kidney transplant recipients (KTRs) from the University of Wisconsin School of Medicine and Public Health who developed DGF between November 2015 and April 2019. Patients were divided into those who received hemodialysis (HD) or PD during the DGF period. Immediate graft explant, DGF among living donor KTRs, or those requiring just a single dialysis treatment were excluded. RESULTS Of 224 KTRs with DGF during the study period, 167 fulfilled our selection criteria. There were 16 patients in the PD and 151 in the HD group. Baseline characteristics were similar between the two groups, except diabetes was more prevalent in the HD group. Five of 16 PD patients had to be transitioned to HD. There was no difference in DGF duration, hospital length of stay, infectious or surgical complications, rejection at various time periods, graft function at last follow-up, or graft failure. In multivariate analysis, only rejection within the first year of transplantation (hazard ratio [HR]: 4.26; 95% confidence interval [CI]: 1.20-15.08; P = 0.02) and post-surgical complications (HR: 3.79; 95% CI: 1.03- 13.91; P = 0.04) were associated with death-censored graft failure (DCGF). The use of PD for treatment of DGF was not associated with DCGF. CONCLUSIONS In carefully selected patients, PD can be continued safely for DGF without any effect on short-term or long-term transplant outcomes.
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Affiliation(s)
- Ali I. Gardezi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brenda Muth
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Adil Ghaffar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fahad Aziz
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Neetika Garg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maha Mohamed
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Foley
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Dixon Kaufman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Arjang Djamali
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier Mandelbrot
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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COVID-19 and Living Donor Kidney Transplantation in Naples during the Pandemic. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5703963. [PMID: 33123577 PMCID: PMC7584967 DOI: 10.1155/2020/5703963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/01/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
Introduction SARS-CoV-2 is a virus that causes a potentially deadly syndrome that affects especially the respiratory tract. Kidney-transplanted patients are immunosuppressed and more susceptible to viral infections. We have examined our transplantation activity to explore the future role of kidney transplantation from deceased and living donors in COVID-19 era. Patients and Methods. The activity of our transplant center of Naples (one of the two transplant centers in Campania, South Italy) continued during the COVID-19 pandemic. We have analysed the kidney transplants carried out between March 9 and June 9, 2020, comparing these data with the numbers of procedures performed in the two previous years. Moreover, we have considered the possibility of performing living donor transplants during a worldwide pandemic. Results From March 9, 2020, when the Italian lockdown begun, till June 9, 2020, five kidney transplants have been performed at our transplant center in Naples, all from deceased donors. The donors and the recipients have been screened for COVID-19 infection, and the patients, all asymptomatic, followed strict preventive measures and were fully informed about the risks of surgery and immunosuppression during a pandemic. All the transplanted patients remained COVID negative during the follow-up. The number of transplants performed has been constant compared to the same months of 2018 and 2019. In agreement with the patients, we decided to postpone living donor transplants to a period of greater control of the SARS-CoV-2 spread in Italy. Conclusion Deceased donor kidney transplantation should continue, especially in a region with moderate risk, like Campania, with a more careful selection of donors and recipients, preferring standard donors and recipients without severe comorbidities. Living donor transplantation program, instead, should be postponed to a period of greater control of the SARS-CoV-2 spread, as it is an elective surgery and its delay does not determine additional risks for patients.
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Peluso G, Incollingo P, Campanile S, Menkulazi M, Scotti A, Tammaro V, Calogero A, Dodaro C, Carlomagno N, Santangelo ML. Relation Between Wound Complication and Lymphocele After Kidney Transplantation: A Monocentric Study. Transplant Proc 2020; 52:1562-1565. [PMID: 32299707 DOI: 10.1016/j.transproceed.2020.02.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/05/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Wound complication frequently arises after kidney transplantation and its risk factors are well known. In a previous paper we analyzed these factors, and in this new retrospective study we evaluate the influence of lymphocele in the development of wound complications. PATIENTS AND METHODS From January 2000 to December 2018, 731 consecutive kidney transplants have been performed in our center. We have analyzed the incidence of wound complication and lymphocele and their risk factors. RESULTS Out of 731 kidney transplants, we have observed wound complications in 115 patients (15.7%) and lymphocele in 158 patients (21.7%). Of these, 70 patients developed both complications (9.5%), but 6 patients have been excluded because they were in therapy with mammalian target of rapamycin inhibitors. Twenty-nine patients (45.3%) presented a first level and 35 patients (54.7%) showed second level wound complications. Lymphocele was the only present factor in just 3 cases (4.6%). The other patients showed diabetes in 28 cases (43.7%), overweight/obesity in 38 (59.3%), delayed graft function in 17 (26.5%), and 60 years or more in 38 (57.8%). The association has been found in 30 out 64 patients treated with tacrolimus (46.8%) and in 34 with cyclosporine (53.1%); 40 patients did not receive muscular layer's reconstruction (62.5%). CONCLUSION Our experience shows that lymphocele alone is not a predisposing factor for wound dehiscence after kidney transplantation, and they often coexist because they share the same risk factors, the most important being obesity, diabetes and delayed graft function, older age, and surgical techniques. No relation has been observed with calcineurin inhibitor therapy.
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Affiliation(s)
- Gaia Peluso
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Paola Incollingo
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Silvia Campanile
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy.
| | - Marsela Menkulazi
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Alessandro Scotti
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Vincenzo Tammaro
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Armando Calogero
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Concetta Dodaro
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Nicola Carlomagno
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
| | - Michele L Santangelo
- Operative Unit of General Surgery and Kidney Transplantation - Advanced Biomedical Science Department - University Federico II of Naples, Naples, Italy
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