Peritoneal Dialysis in Orthotopic Liver Transplantation Recipients

Saiprasertkit, Nalinee; Nihei, Camila Hitomi; Bargman, Joanne M.

doi:10.3747/pdi.2017.00134

Cited by 13 publications

(26 citation statements)

References 20 publications

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“…Two studies allowed direct comparisons of the rate of peritonitis in LT patients to that observed in cohorts of nontransplanted PD patients (see Table 3). 16,17,20 When pooling the reported experience from this systematic review, an overall peritonitis incidence rate of 1/34 patient-months was found, which represents 0.35 infections per patient-year. This rate is slightly higher than that recently reported for general PD population in Canada (0.27; 95% CI: [0.25, 0.30]) and Australia/New Zealand (0.29; 95% CI: [0.26, 0.32]) but similar to that observed in the United Kingdom (0.35; 95% CI: [0.30, 0.40]).…”

Section: Discussionmentioning

confidence: 95%

“…Careful planning of early PD catheter insertion in patients with progressive deterioration of kidney function may also reduce the risk of requiring urgent HD initiation prior to PD by permitting sufficient time for wound healing. 11,20 Only 1 case report quantitatively mentioned dialysis adequacy using Kt/v. 21 However, all other studies reported that dialysis adequacy for these patients was within standard recommendations until the end of follow-up, death, or kidney transplantation, except for one.…”

Section: Discussionmentioning

confidence: 99%

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Peritoneal Dialysis After Liver Transplantation: A Systematic Review

Côté

Éthier

Cardinal

et al. 2021

Can J Kidney Health Dis

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Background: Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear. Objective: To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis. Design: Systematic review. Setting: Interventional and observational studies reporting the use of PD after liver transplantation. Patients: Adult liver transplant recipients with kidney failure treated with maintenance KRT. Measurements: Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate. Methods: The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results. Results: From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function. Limitations: Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution. Conclusions: Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed. Registration (PROSPERO): CRD42020218374.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Peritoneal Dialysis After Liver Transplantation: A Systematic Review

Côté

Éthier

Cardinal

et al. 2021

Can J Kidney Health Dis

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“…This may be par- ticularly true in the case of remote events, in which clinical information may be incomplete. The option of PD is often discouraged in patients with this type of background [2][3][4][5][6], although this therapy has proven to be feasible even after seemingly aggressive abdominal procedures, including limited intestinal resections, liver transplantation [9], or bariatric surgery [10]. Computed tomography may identify overt distortions of the peritoneal structure but, in general, lacks sensitivity to detect less obvious cases.…”

Section: Discussionmentioning

confidence: 99%

Does Prior Abdominal Surgery Influence Peritoneal Transport Characteristics or Technique Survival of Peritoneal Dialysis Patients?

et al. 2020

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Introduction: Prior abdominal surgery may result in peritoneal membrane adhesions and fibrosis, compromising the success of peritoneal dialysis (PD). The impact of this factor on peritoneal membrane function and PD technique survival has not been adequately investigated. Methods: Following an observational, retrospective design, we studied 171 incident PD patients, with the main objective of analyzing the influence of prior abdominal surgical procedures (main study variable) on baseline and evolutionary peritoneal transport characteristics (main outcome) and PD patient and technique survival (secondary outcomes). Abdominal surgeries were categorized according to the degree of presumed injury to the peritoneal membrane. We also considered the additive effect of aggressions to the membrane during the first year on PD therapy. Results: All patients had a baseline peritoneal equilibration test with complete drainage at 60′, and 113 patients had a second study at the end of the first year. Sixty-one patients (35.7%) had a record of prior abdominal surgery, including 29 patients with at least one major intraperitoneal surgery, 22 having undergone minor intraperitoneal procedures, and 21 with a background of major abdominopelvic extraperitoneal surgery. We did not observe differences, at baseline or after 1 year, among patients with or without previous abdominal procedures regarding small solute transport, overall capacity of ultrafiltration, free water transport, small pore ultrafiltration, or peritoneal protein excretion. Stratified analysis, considering prior and first-year-on-PD peritoneal aggressions, did not reveal any differences, although in this case our analysis was hampered by a limited statistical power. Abdominal surgical events did not influence patient or PD technique survival. Conclusion: Prior abdominal surgical procedures do not appear to compromise peritoneal membrane function or technique survival in patients successfully started on PD.

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“…Anti-coagulant drugs used in HD aggravate bleeding. However, anti-coagulant drugs are not involved in PD, and thus PD may not aggravate bleeding (1). Peritoneal dialysis may also slowly clear up solutes, which could explain the previous finding that the prevalence of hypotension is relatively lower in PD than in HD (26).…”

Section: Discussionmentioning

confidence: 99%

“…A s the prevalence of end-stage renal disease (ESRD) continues to increase with the burden of chronic kidney disease, the need for a cost-effective renal replacement modality has been increasing. Peritoneal dialysis (PD) as a treatment option for patients with ESRD is an attractive therapy, providing greater cost-effectiveness and less hemodynamic stress with a lower bleeding tendency than hemodialysis (HD) (1). Another advantage of PD is less travelling for dialysis maintenance, which may appeal to patients lacking adequate transportation or living long distances from dialysis facilities (2).…”

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confidence: 99%

Effect of Liver Cirrhosis on the Outcomes of Peritoneal Dialysis

et al. 2019

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Background Peritoneal dialysis (PD) has become an increasingly important treatment modality for end-stage renal disease. However, application of PD in patients with liver cirrhosis (LC) and subsequent outcomes have not been thoroughly evaluated. Methods A total of 1,366 patients (≥ 18 years old) who started PD at 4 tertiary referral centers between January 2000 and December 2015 were initially reviewed. Among them, 45 patients with LC were finally analyzed (LC-PD). Using the multivariate Cox hazard ratio (HR) model, outcomes such as technique failure, infection, and mortality in patients with LC-PD were compared with those in non-LC-PD patients (non-LC-PD) or patients with LC who received hemodialysis (LC-HD). All of the patients were selected by 1:1 matching of age, sex, catheter insertion date, and diabetes mellitus. Results During the mean follow-up duration of 43 ± 35.8 months, 12 patients with LC-PD experienced technique failure, and this rate was similar to that of non-LC-PD patients. In evaluating infection episodes, the most common causes for peritonitis and exit-site infection were Escherichia coli (5.8%) and Staphylococcus aureus (19.3%), respectively; these event rates of LC-PD did not differ from those of non-LC-PD. The all-cause mortality rate of the LC-PD group was not different from that of the non-LC-PD and LC-HD groups. Conclusion Dialysis outcomes such as technique failure, infection, and mortality are not affected by the presence of LC. Accordingly, PD therapy is a good option in patients with LC.

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Peritoneal Dialysis in Orthotopic Liver Transplantation Recipients

Cited by 13 publications

References 20 publications

Peritoneal Dialysis After Liver Transplantation: A Systematic Review

Peritoneal Dialysis After Liver Transplantation: A Systematic Review

Does Prior Abdominal Surgery Influence Peritoneal Transport Characteristics or Technique Survival of Peritoneal Dialysis Patients?

Effect of Liver Cirrhosis on the Outcomes of Peritoneal Dialysis

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