**1. Introduction**

[31] Kelly, K.J., et al., P53 mediates the apoptotic response to GTP depletion after renal ischemia-reperfusion: protective role of a p53 inhibitor. J Am Soc Nephrol, 2003.

[32] Megyesi, J., et al., The p53-independent activation of transcription of p21 WAF1/ CIP1/SDI1 after acute renal failure. Am J Physiol, 1996. 271(6 Pt 2): p. F1211-F1216. [33] Turner, C.M., et al., Increased expression of the pro-apoptotic ATP-sensitive P2X7 re‐ ceptor in experimental and human glomerulonephritis. Nephrol Dial.Transplant,

[34] Takemura, T., et al., Proto-oncogene expression in human glomerular diseases. J

[35] Qiu, L.Q., R. Sinniah, and S.I. Hsu, Coupled induction of iNOS and p53 upregulation in renal resident cells may be linked with apoptotic activity in the pathogenesis of

[36] Wynn, R.F., et al., Accelerated telomere shortening in young recipients of allogeneic

[37] Oberbauer, R., et al., Apoptosis of tubular epithelial cells in donor kidney biopsies predicts early renal allograft function. J.Am.Soc.Nephrol., 1999. 10(9): p. 2006-2013.

[38] Vinuesa, E., et al., Macrophage involvement in the kidney repair phase after ischae‐

[39] Koppelstaetter, C., et al., Markers of cellular senescence in zero hour biopsies predict

[40] Verzola, D., et al., Accelerated senescence in the kidneys of patients with type 2 dia‐

[41] Westhoff, J.H., et al., Hypertension induces somatic cellular senescence in rats and humans by induction of cell cycle inhibitor p16INK4a. Hypertension, 2008. 52(1): p.

[42] Chkhotua, A.B., et al., Increased expression of P21((WAF1/CIP1)) CDKI gene in chronic allograft nephropathy correlating with the number of acute rejection epi‐

[43] Hochegger, K., et al., p21 and mTERT are novel markers for determining different is‐ chemic time periods in renal ischemia-reperfusion injury. AJP - Renal Physiology,

progressive IgA nephropathy. J Am Soc Nephrol, 2004. 15(8): p. 2066-2078.

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192 Current Issues and Future Direction in Kidney Transplantation

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For patients with end-stage renal disease renal transplantation is the treatment of choice. However, there is still some controversy if mortality rate after renal transplantation is affected by the chosen dialysis modality.

It is widely accepted, that in terms of survival hemodialysis (HD) and peritoneal dialysis (PD) are comparable. Especially in PD-patients with preserved residual renal function, control of hypertension is achieved more easily, whereas patients with diabetes mellitus do better on HD. In general, quality of life for patients is assumed to be better with PD than with HD [1].

In a cost-modeling strategy, incorporating quality of life and social perspective aspects in Scandinavia, it was shown, that the cost per quality-adjusted life year for PD was lower compared to HD in all analyzed age groups, whereas mean survival and frequency of transplantation did not differ [2].

Despite technological advance, only 15 % of the world dialysis population is managed by PD. Therefore, a "integrated approach" suggests starting PD in alarge percentage of patients, especially when renal transplantation is expected in the next 2 or 3 years after initiation of dialysis [3].

A very interesting point became obvious when analyzing data obtained from the Dialysis Morbidity and Mortality Study Wave 2, a national random sample of more than 4000 new dialysis patients in the USA enrolled during 1996 and 1997 and followed up until 2001. There, it was shown, that transplantation rates were significantly higher for patients reporting the greatest contribution to modality selection. These results support the association of patient

autonomy with transplantation and survival, probably in favor for patients actively choosing PD as their dialysis modality [4]. Also, a small Japanese single center study in 42 patients analyzed the effect of dialysis modality on rate of kidney transplantation from living donors and transplant outcome. There were no differences between the two modalities prior to transplantation in the graft survival rate, incidence of acute rejection, and complications before and after transplantation.However, The transfer rate from PD to transplantation was signifi‐ cantly (p = 0.0036) higher (4.7%) than that of HD (1.9%). Probably reflecting better cooperation between with the patients, their family and the provision of relevant information by nephrol‐ ogists during PD [5].

**3. Renal transplantation in PD–patients – first experience**

rable results for patients with PD compared to HD patients[17].

arterial thrombosis and graft function recovery was not different [18].

**4. PD versus HD and survival after renal transplantation**

neal dialysis was necessary, while 10 patients developed peritonitis [22].

The incidences of infections were also similar in the two groups [23].

**5. PD and complications after renal transplantation**

shown [16].

The first experience about the use of peritoneal dialysis in patients waiting for renal trans‐ plantation were published in some very early reports describing the feasibility of PD for patients awaiting renal transplantation[13-15]. Also in a small series of 15 patients the experi‐ ence with renal transplantation in PD-patients was reported. Despite the fact, that some of the PD patients had peritonitis at the time of transplantation, no differences in graft survival were

Comparison of Renal Transplantation Outcomes in Patients After Peritoneal Dialysis and Hemodialysis…

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Similar results were published in an early study with a group of 44 patients, showing compa‐

Also, a small study in 9 PD patients reported significantly greater and longer wound drainage in PD patients. However, the incidence of acute rejection episodes, delayed graft function, graft

In a retrospective analysis of 61 PD and 159 HD patients there were no differences in survival of patients or grafts between the two treatment groups. One year after transplantation the percentages of survivors who had received continuous ambulatory peritoneal dialysis and hemodialysis were 88% and 91% respectively, and overall graft survival was 66% and 72%, respectively [19]. Similar results were reported from 42 PD patients, either treated with CAPD for more than 26 weeks or less than 26 weeks in comparison with 55 HD patients, irrespectively if treated with azathioprine + prednisolone or cyclosporine + prednisolone [20]. A retrospective analysis of 389 patients transplanted between Juli,1974, and July 1985, also evaluated the effect of dialysis modality on transplantation and mortality rates. By correcting for the influence of different variables and using time-dependent treatment co-variables, the bias adjusted estimates of the relative risk of death did not differ significantly from one another [21]. A cohort analysis of 500 first renal transplant recipients (241 on CAPD, 259 on HD) showed identical graft and patient survival after five years. However in 37 PD patients post-transplant perito‐

In 54 patients with renal transplantation after PD compared to 48 patients after HD with an immunosuppressive regimen consisting of prednisolone, azathioprine and cyclosporine there no significant difference in patient mortality and survival or graft survival between the groups.

There is some concern with respect for the risk of infections, especially peritonitis caused by the peritoneal catheter in PD patients. In a retrospective single center analysis the experience
