Assessing Surgical Feasibility of Peritoneal Dialysis Following Liver-Lung Transplantation: A Case Report

Kidney failure is a common complication in recipients of nonkidney solid organ transplants (NKSOT), often stemming from prolonged calcineurin inhibitor (CNI) exposure or perioperative insults. Although haemodialysis (HD) remains the predominant renal replacement therapy (RRT), peritoneal dialysis (PD) offers advantages such as better quality of life, haemodynamic stability and preservation of residual renal function. Concerns about infection risk, technical feasibility and respiratory complications have curtailed its broader use. We present the first reported case of successful PD in a liver and double-lung transplant recipient. The patient, a 30-year-old male with cystic fibrosis, extensive abdominal surgery and immunosuppression, was initially deemed unsuitable for PD due to surgical complexity and potential complications in a transplant recipient. A multidisciplinary team (MDT) review at our liver and kidney transplant specialist centre ultimately supported PD based on clinical suitability and lifestyle preferences. Laparoscopic catheter insertion was achieved despite significant intra-abdominal adhesions, and the patient remained on PD for 18 months without complications. This case underscores that with meticulous surgical planning and MDT input, PD can be a safe and viable option in complex NKSOT recipients. It challenges prevailing biases against PD in this population and suggests that prior transplantation should not preclude its consideration.