There appears to be no specific concern related to liver transplant patients undergoing PD. Peritonitis and mortality rates were no different from other solid organ recipients or even from the general PD population. The hepatic graft was never threatened, even during peritonitis. Therefore, these patients should not be denied the option of PD.

Our data suggest that APD may have lower risk of treatment failure compared with double-bag CAPD. These potential benefits of APD might justify the use of this modality despite its higher cost.

An abnormal lactate value is often seen in PD patients presenting to the ED, even in the absence of signs of hemodynamic instability, and very rarely indicates bowel ischemia. We postulate that in the setting of an acute intercurrent illness, there is a transient disruption in the metabolism of lactate absorbed from the PD fluid. This novel observation suggests that elevated serum lactate in the sick PD patient does not necessarily indicate tissue hypoperfusion or gut ischemia and may obviate unnecessary investigations.

COrrESPOnDEnCEOutcomes of C. jeikeium infections are often poor. Based on the literature, the overall mortality of patients with C. jeikeium infections is 33% even after treatment with appropriate antibiotics, and the rate rises further (to 41%) if endocarditis is also found (6). This high risk of an adverse outcome might stem from the severity of host immune suppression and the sites of bacterial residence (prostheses or cardiac valves) (6,7). Earlier treatment with an effective antibiotic is of paramount importance in C. jeikeium peritonitis so as to preserve the peritoneum and prevent technique failure.