Background: In India, a large number of end-stage renal disease patients are undergoing renal replacement therapy. A successful renal transplantation relives the burden of dialysis with improved quality of life and a productive life thereafter. This also reduces the cost of health care to the government and the society. Graft dysfunction is an important cause of graft loss. The objective of this retrospective study is to evaluate the graft dysfunction and its impact on patient and graft survival. Methods: We did a retrospective record-based analysis of 83 cases (including both deceased and live-related renal transplants) from 2014 to 2019 who were on triple immunosuppression (tacrolimus, mycophenolate mofetil, and steroids) as maintenance therapy. Patients who had graft dysfunction, underwent graft biopsy and were analyzed subsequently. Results: The most common causes for graft dysfunction on biopsy were acute rejection, acute tubular injury, and calcineurin inhibitor toxicity. About 39% of the patients had infections, predominantly bacterial and viral infections. The rejections were associated with poor patient survival (statistically significant). The overall patient survival at our center after 1 year and 3 years was 88% and 84%, respectively, while the death-censored graft survival was 86% and 81%, respectively. Conclusion: In our center, following renal transplantation, patients had a fairly successful outcome. However, early detection and prompt management of the graft dysfunction can improve the graft and the patient survival.

Peritoneal dialysis (PD) is a type of renal replacement therapy which is based on the use of peritoneum, which acts as a semipermeable membrane with diffusion and convection. Long term use can produce structural and functional changes of the membrane by the activation of the resident fibroblasts and infiltrating inflammatory cells, mesothelial to mesenchymal transition, further leading to fibrosis, angiogenesis and ultrafiltration failure. This is due to use of bioincompatible fluids, frequent peritoneal inflammation, uremic milieu and other multiple factors. The peritoneal fibrosis has two parts: fibrosis and inflammation, which induces each other via TGF/SMAD pathway and IL-6 signaling, respectively. The advent of newer biocompatible fluids along with additives has significantly reduced the production of glucose degradation products (GDPs). In addition, the identification of the biomarkers in peritoneal effluent is necessary, which, after being correlated with peritoneal biopsy, may help us to guide future studies and assessment of the efficacy of therapeutic interventions. Various interventions are being tried based on experimental studies from animal models, pharmacology and gene therapy with promising results, with new insights in near future. This article reviews the main aspects associated with the functional and structural alterations related to PD and discusses interventions whereby we may prevent them to preserve the peritoneal membrane.

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