Case Report
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World J Transplant. Jun 24, 2013; 3(2): 26-29
Published online Jun 24, 2013. doi: 10.5500/wjt.v3.i2.26
Residual renal function in peritoneal dialysis with failed allograft and minimum immunosuppression
Nadear Elmahi, Éva Csongrádi, Kenneth Kokko, Jack R Lewin, Jamie Davison, Tibor Fülöp
Nadear Elmahi, Éva Csongrádi, Kenneth Kokko, Jamie Davison, Tibor Fülöp, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States
Éva Csongrádi, Department of Medicine, Medical and Health Science Center, University of Debrecen, 4032 Debrecen, Hungary
Jack R Lewin, Department of Pathology, University of Mississippi Medical Center, Jackson, MS 39216, United States
Author contributions: Elmhi N collected the data, reviewed the patient chart, wrote the initial draft of the paper, performed the literature review, submitted the paper and will be the correspondent; Csongrádi É revised the manuscript and checked the clinical relevance of the case; Lewin JR reviewed and presented the tissue pathology and histology slides; Kokko K performed critical manuscript revision; Davison J collected data and performed clinical case review; Fülöp T the senior author of the case, wrote the abstract, helped with the manuscript development and coordinated the manuscript revisions.
Correspondence to: Nadear Elmahi, MD, MPH, Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, United States. nxhelma@gmail.com
Telephone: +1-601-9845670 Fax: +1-601-9845765
Received: January 25, 2013
Revised: March 29, 2013
Accepted: April 10, 2013
Published online: June 24, 2013
Processing time: 133 Days and 1.6 Hours
Abstract

Immunosuppression (IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function (RRF). As maintenance of RRF appears to provide a survival benefit to peritoneal dialysis (PD) patients, it is not clear whether this benefit of maintaining RRF in failed allograft patients returning to PD outweigh the risks of maintaining IS. A 49 year-old Caucasian male developed progressive allograft failure nine years after living-donor renal transplantation. Hemodialysis was initiated via tunneled dialysis catheter (TDC) and IS was gradually withdrawn. Two weeks after IS withdrawal he developed a febrile illness, which necessitate removal of the TDC and conversion to PD. He was maintained on small dose of tacrolimus (1 mg/d) and prednisone (5 mg/d). Currently (1 year later) he is doing exceedingly well on cycler-assisted PD. Residual urine output ranges between 600-1200 mL/d. Total weekly Kt/V achieved 1.82. RRF remained well preserved in this patient with failed renal allograft with minimal immunosuppressive therapy. This strategy will need further study in well-defined cohorts of PD patients with failed allografts and residual RRF to determine efficacy and safety.

Keywords: Immunosuppression; Kidney transplantation; Nephrectomy; Peritoneal dialysis; Renal function reserve

Core tip: Making decision regarding the optimal management of immunosuppression is one the most challenging decisions following allograft failure. The use of low dose immunosuppressive medications is the most reasonable approach. Many patients with failed allograft require renal replacement therapy. Peritoneal dialysis (PD) remains underused modality in failed renal allograft, especially in patients with residual renal function (RRF). Our patient failed renal transplant and was initiated on PD and maintained on minimal immunosuppression. Interestingly, his RRF remained well preserved. We recommend further study in well-defined cohorts of PD patients with failed allografts and RRF to determine efficacy and safety.