CAPD and renal transplantation

Abstract

Continuous ambulatory peritoneal dialysis (CAPD) is believed to improve the immune competence of end-stage renal failure patients and to increase the risk of graft rejection following subsequent renal transplantation. At this centre, 220 consecutive renal transplants have been studied in patients treated by either CAPD or haemodialysis (HD). Patient and graft survival was not significantly different for the two treatment groups over a five year follow-up. When only first cadaver recipients were considered (152 grafts) one-year graft survival (non-immunological failures excluded) was 77 per cent for CAPD and 79 per cent for HD patients (P greater than 0.05). Time on dialysis and number of pre-operative transfusions were significantly greater for the HD patients (P less than 0.05). A group of HD and CAPD patients were identified as being matched for age, sex, HLA, A, B, DR antigen matches, pre-operative transfusions and time-on dialysis. One-year graft survival of the CAPD patients was 82 per cent and for the HD patients 61 per cent. Studies of patient lymphocyte function and plasma suppressive activity in vitro revealed no differences between CAPD and HD treated patients. CAPD is not an immunological risk factor in renal transplantation and its continued use in the preparation of patients for transplantation is recommended.

Intact Humoral Immune Response in Patients on Continuous Ambulatory Peritoneal Dialysis

“…After matching for time on dialysis, original neph ropathy and age these differences remained statistically significant. Although the literature is conflicting as to whether CAPD patients are immunosuppressed or not [11,12], in this study apparently CAPD treatment does not lead to the immunosuppressive state associated with HD treatment. As the antibody formation against the hemag glutinin component of the influenza viruses is a T cell-dependent phenomenon [13,14], the normal response to vaccination in CAPD patients suggests both an intact humoral and cellular immunity.…”

Peritoneal Dialysis for Potential Kidney Transplant Recipients: Pride or Prejudice?

“…For many years, in-center hemodialysis (ICHD) has represented the only option available [12,13]. In the 1980s, the introduction of peritoneal dialysis (PD) into clinical practice [14,15], raised the question of which RRT should have been preferred in potential KT recipients [16][17][18][19]. Main concerns regarding the routinary use of PD in this particular population were the presence of peritoneal scarring due to previous abdominal surgery, the risk of peri-operative peritonitis [20,21] or exit-site/tunnel infections [20,22], the higher susceptibility to post-transplant diabetes mellitus [23,24], the possible development of encapsulating peritoneal sclerosis [25,26], and the perceived increase in graft thrombosis [23,[27][28][29]] and acute rejection rates [16,30].…”