Peritoneal dialysis in end-stage renal disease after liver transplantation.

Peritoneal dialysis (PD) has seldom been reported in patients developing end-stage renal disease (ESRD) after liver transplantation (LTx). Here we present our recent experience with PD in 5 such patients. Of the 5 patients, 3 were men and 2 were women. Average age at initiation of PD was 64.6 years (range: 54 - 72 years). Chronic renal failure (CRF) was diagnosed an average of 3.8 years (range: 1 - 7 years) post transplant and resulted in ESRD an average of 9.2 years (range: 6 - 15 years) after LTx. Calcineurin inhibitor toxicity was the presumed causative factor in all 5 patients, with biopsy confirmation in 2. All of the patients had hypertension at the time of diagnosis of CRF, 2 had coronary artery disease, and 1 developed diabetes mellitus. No patient had ascites before PD initiation. Peritoneal dialysis catheter implantation was uneventful in all patients. Average duration of follow-up was 13.6 months (range: 6 - 29 months). Three episodes of peritonitis occurred in 2 patients (coagulase-negative staphylococcus, Staphylococcus aureus, and Acinetobacter). All episodes of peritonitis responded to standard treatment. Clearance was found to be adequate in all but 1 patient. One patient died 19 months after initiation of PD. At the time of writing, the remaining 4 patients are alive on PD after an average of 12.2 months (range: 6 - 29 months). We conclude that PD is a viable and safe option for managing ESRD that develops after LTx.