Managing peritoneal dialysis catheter after kidney transplant

Introduction: Peritoneal dialysis is a kidney replacement therapy with outcomes comparable to hemodialysis, although kidney transplantation remains the optimal treatment. The appropriate timing for removing the peritoneal dialysis catheter after transplantation is uncertain, as it may affect patient recovery and graft performance. This study aimed to evaluate infectious complications associated with retained peritoneal dialysis catheters after transplantation and to identify a suitable moment for their removal. Methods: A retrospective review of all patients who underwent kidney transplantation between January 2013 and June 2023 was performed. Descriptive and inferential analyses were used to assess the timing of catheter removal, catheter-related infections, and post-transplant dialysis needs. Continuous variables were analyzed with the Mann-Whitney U test, while nominal variables were evaluated using Chi-square or Fisher’s exact tests. Results: The median time to catheter removal was 4.5 months. Infectious complications occurred in 21 patients, representing 17.2% of the cohort, with exit-site infections being the most frequent event. Donor type and prior infections did not significantly influence infection rates. In living-donor transplantations, only 4.5% of catheters were removed during the transplant surgery. Discussion: These findings support individualized decisions regarding peritoneal dialysis catheter removal, particularly for patients with a low risk of delayed graft function. A risk-based decision algorithm is proposed to assist clinicians. Although current practice aligns with existing guidance, the infectious risks linked to maintaining the catheter suggest that earlier removal should be considered. A tailored approach may improve clinical outcomes and facilitate a safer transition from peritoneal dialysis to kidney transplantation.