PURPOSE To review the peritoneal dialysis (PD) catheter outcomes at our center and assess factors affecting the catheter survival. METHODS We carried out a retrospective study on 315 patients who had their first PD catheter placed between January 2001 and September 2009 at the UT Southwestern/DaVita Peritoneal Dialysis Clinic at Dallas, Texas. Medical records were reviewed for demographic and clinical information of the patients. The primary end point of the study was PD catheter failure, defined as removal of a dysfunctional PD catheter due to catheter-related complications. Catheter survival was estimated using Kaplan Meier method. Cox proportional hazard regression model was used to identify factors that are independently associated with catheter survival. RESULTS The mean age of the patients was 49.7 +/− 29 years. The study population included 54.6% females; 42.5% African American, 27.9% Caucasian and 22.9% Hispanic patients. Diabetes was the primary etiology of end-stage renal disease in 43.2% of patients. More than 90% of patients had one or more co-morbidities; and 57.5% had previous abdominal surgery. The mean BMI for the group was 28.6 +/− 13.8 kg/m2. Less than a quarter of the patients (24.1%) had non-infectious/mechanical catheter problems. Overall PD catheter survival rates over 12, 24 and 36 months were 92.9%, 91.9% and 91.1%, respectively. PD catheter-related non-infectious problem was the only independent variable that was significantly associated with catheter survival (Hazard ratio 22.467; 95% CI 6.665– 75.732). No significant association was observed between the PD catheter survival and other risk factors including age, BMI, diabetic status, comorbidities, previous abdominal surgeries or infections. CONCLUSIONS Our study shows an excellent 3-year PD catheter survival (91.1%). Only PD catheter-related non-infectious problems are significantly associated with catheter failure. Other factors such as age, gender, race, BMI, diabetic status, comorbidities, previous abdominal surgeries, peritoneal infections or exit-site/ tunnel infections were not found to affect the PD catheter survival and should not be considered barriers to PD initiation.

BackgroundRabbit antithymocyte globulin (rATG) is the most widely used kidney transplant induction immunotherapy in the United States. It was recently Food and Drug Administration approved for this indication with typical dose recommendations of 1.5 mg/kg for up to 7 days given via a central line.MethodsWe theorized that reduced rATG dosing when compared with conventional dosing (6-10.5 mg/kg) is safe and effective, leading to development of a risk-stratified treatment protocol. Five-year data from a retrospective cohort of 224 adult kidney transplants (2008-2013) with follow-up through 2015 is presented. Cumulative rATG doses of 3 mg/kg were administered peripherally to nonsensitized living donor recipients, 4.5 mg/kg to nonsensitized deceased donor recipients. A subset of higher immunologic risk recipients (defined as history of prior transplant, panel reactive antibody greater than 20%, or flow cytometry crossmatch positivity) received 6 mg/kg.ResultsThere were no differences in patient or graft survival between the 3 groups. One-year rejection rates in the first 2 groups were 8.3% and 8.8%, respectively, comparable to contemporaneous rates reported to the Scientific Registry of Transplant Recipients. Dose tailoring permitted substantial cost savings estimated at US $1 091 502. Mean length of stay fell by almost 3 days as the protocol was refined. There were no episodes of phlebitis. Infection rates were comparable with those reported to the Scientific Registry of Transplant Recipients.ConclusionsThe novel findings of the current study include peripheral administration, reduced dosing, favorable safety, excellent allograft outcomes, and clear associative data regarding reduced costs and length of stay.

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