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Abstract Background and Aims Despite progress in kidney transplant medicine, there are still patients experiencing graft failure and returning to dialysis therapy. Data regarding the prognosis of these patients remain conflicting. This study was conducted to compare clinical outcomes between transplant-naïve peritoneal dialysis (PD) patients and those returning to PD after a failed allograft. Method In this retrospective cohort study during 2006 and 2016, we included a total of 786 patients on chronic PD. Of them 679 were transplant-naïve, 76 patients underwent a successful transplantation, and 32 patients returned to PD after a failed kidney allograft. Baseline demographics and clinical characteristics were analyzed in relation to the outcomes of all-cause mortality and peritonitis rate. We employed the Kaplan-Meier method and Cox proportional hazards model to evaluate survival, while Poisson regression was utilized to estimate rate ratios for peritonitis. Results During a median follow-up of 6.37 years, 56.68 % death and 146.62 episodes of peritonitis/patient-year were observed. Compared with patients who received a kidney graft, transplant-naïve patients were older, more with diabetes and having higher mortality (58.6 ± 15.8, 40.5% and 57.73%, p 0.0001). After accounting for age, gender, and comorbidities, the adjusted hazards ratios were 0.26 (95% CI 0.13-0.53) in patients with a functioning graft and 1.12 (95% CI 0.61-2.06) in patients returning to PD after graft failure, compared respectively with concurrent PD patients without kidney transplant. The adjusted relative risk of peritonitis in patients resuming PD after graft failure was comparable to those without kidney transplant (95% CI 0.22-1.14). Conclusion Successful kidney transplant reduced the risk of overall mortality among patients on long-term PD. Patients returning to PD after graft loss showed outcomes similar to transplant-naïve counterparts. These data support reactivation of PD as a viable option for patients with a failed kidney transplant.
Yi‐Ting Chen (Wed,) studied this question.