Vth International Course on Peritoneal Dialysis 0896-8608/94 $300 + 00 May 24 27,1994, Vicenza, Italy Copyright @ 1994 International Society for Peritoneal Dialysis Pcritoneal Dialysis International, Vol. 14, Suppl 3, 1994 Printed in Canada All rights reserved KIDNEY TRANSPLANTATION IN PERITONEAL DIALYSIS PATIENTS Rosario Maiorca, Silvio Sandrini, Giovanni C. Cancarini, Corrado Camerini, Francesco Scolari, Luciano Cristinelli, and Maria Filippini Chair of Nephrology, University of Brescia and Division of Nephrology, Spedali Civili, Brescia, Italy p eritoneal dialysis (PD) is a well-established method for the treatment ofuremia, but its suit ability for patients receiving a transplant has been a matter of controversy. In this paper we shall compare the resu lts in the literature of kidney transplants in patients formerly on PD, mainly continuous ambulatory peritoneal dialysis (CAPD), and on hemodialysis (HD). We will also report our personal experience with comparable groups of patients. PERSONAL EXPERIENCE In our center we started to transplant kidneys in 1979 and have been usingcyclosporine as animmunosuppressant since October 1983. Since then, to 31 August 1993, we have performed 299 cadaveric transplants in 288 patients, all treated with cyclosporine, usually with steroids, or alone from the time oftransplantation or 6 months post transplantation. We used triple therapy, cyclosporine plus steroid and azathioprine, for the minority of patients. Use of monoclonal antibodies (a-OKT3) was limited to steroid- resistant of acute rejection episodes. We have published elsewere (1) our criteria for diagnosis of rejection and the immunosuppressive schedules. Thirty-four patients were on CAPD before receiv ing a kidney transplant. These patients were compared with 38 patients, selected from 254 patients on HD, matched for age (39&plusmn;10 vs 38&plusmn;13 years), year of transplant, and HLA -A,B mismatches (1.8&plusmn;0.8 vs 1.9&plusmn;0.7). The male/female ratios ( 1.71 vs 1.12) were not significantly different. However, the two groups KEY WORDS: Kidney transplantation; hemodi alysis; viral hepatitis. Correspondence to: R. Maiorca, Chair of Nephrology of University of Brescia, Division of Nephrology, Spedali Civili, Piazza Spedali Civili, 1,25123 Brescia, Italy. di d differ in the length of pretransplant dialytic treatment, which were significantly longer for the HD group than the CAPD group (4.4&plusmn;4.2 vs 2.4&plusmn;2.2 years, p < 0.003). Primary renal diseases were glomerular nephropathy in 13 CAPD and 7 HD patients, interstitial nephropathy in 3 and 1, polycystic kidney disease in 2 and 3, malformation in 6 and 6, SLE in 1 CAPD, Fabry's disease in 1 HD, and undiag nosed in 8 CAPD and 10 HD patients. PRETRANSPLANTEVALUATION Pretransplantation CAPD and HD patients may be in different conditions. This is usually neglected in the literature, but the pre transplant condition might influence the intra and postoperative risk (2). In CAPD patients the control of hypertension has been said to be similar to or better than on HD. Anemia can be less severe, and this can reduce the intraoperative need for transfusion (3), but these differences have been reduced since human recombinant erythropoietin has been used. Our CAPD and HD patients differed in residual diuresis (700 &plusmn;590 vs 300&plusmn;390 mL, p < 0.001), but the dialysis period on HD was longer as mentioned above. Serum proteins were significantly lower on CAPD than on HD (6.4&plusmn;0.9 vs 7.5&plusmn;0.8 g/dL, p < 0.01), and albumin was also lower (3.8&plusmn;0.8 vs 4.5&plusmn;0.6 g/dL, p < 0.01). Serum transferrin (275&plusmn;60 vs 267&plusmn;74 mg/dL), serum cholesterol (223&plusmn;62 vs 203&plusmn;67 mg/dL) and hemoglobin (9.6&plusmn;1.7 vs 9.8&plusmn;2.2 g/dL) were not different. At the time of transplantation, our CAPD and HD patients did not differ in hepatitis C virus (HCV) positive percentages (2nd-generation ELISA test), 12% versus 11 %, but only part of the patients in both groups had been tested for HCV antibodies (Figurel). This is at variance with d ata in the literature showing less positivity, often significantly so, in patients on CAPDthan on HD, 0% - 17%versus 13%-44%(4- 9). Hepatitis B virus (HBV) infection was seen in more