[Effect of pretransplant dialysis modality on incidence of early posttransplant infections in kidney recipients].

INTRODUCTION: Infection is one of the main causes of patient death and graft failure early after kidney transplantation. Effect of pretransplant dialysis modality on incidence of infections after kidney transplantation still remains controversial. The aim of the present study was to determine the impact of pre-transplant dialysis modality on incidence urinary tract infections (UTI) and sepsis in early posttransplant period in kidney transplant recipients.

MATERIALS AND METHODS: In this case-control retrospective study a cohort of 72 kidney, kidney- pancreas or kidney-liver transplant recipients was included. Infection was defined by either clinical presentation or microbiological finding. Infections were categorized by localization and cause of infection. In patients on peritoneal dialysis peritoneal catheter was removed intraoperatively during transplantation. Infection rate during first three months posttransplant was analyzed. Difference in frequencies was calculated using nonparametric tests. Proportions were calculated using chi2 test. Time to first infection was analyzed using Kaplan-Meier survival analysis, p value < 0.05 criterion was used to decide statistical significance.

RESULTS: The total number of infections per patient per day was not significantly different in peritoneal vs. hemodialysis modality (0,029 +/- 0.019 to 0,029 +/- 0,031, p=ns). Also, there was no significant difference in peritoneal vs. hemodialysis modality in the number of UTI (0.0156 +/- 0.0144 to 0,0165 +/- 0,0125, p=ns) and sepsis (0.0018 +/- 0.0044 to 0.0026 +/- 0.0019, p=ns) during first three months posttransplant. Similarly, no difference was noted between the groups in the location or cause of infection. Peritonitis prior to transplantation was not an independent risk factor for infections (p=0.37). In Cox regression PD was not an independent risk factor for either total infections, UTI, or sepsis.

CONCLUSION: This study showed that there was not statistically significant difference in the risk for infection in first three months after kidney transplantation with respect to pretransplant dialysis modality. PD should be the first choice for renal replacement therapy in patients with end stage renal disease.