Retained Peritoneal Dialysis Catheter Following Kidney Transplantation: Challenges of Managing Patients with Proper Travel for Transplantation

Introduction: Transplant tourism refers to the transportation of organs, donors, or recipients between states or countries for transplant commercialism. In contrast, jurisdictional borders can be crossed via proper travel for transplantation (PTT). However, PTT presents challenges, including variable practice patterns and limited medical records, as highlighted in this case report. Case Description: A 41-year-old male with ESKD due to primary FSGS was waitlisted for kidney transplant in the USA. He had a peritoneal dialysis (PD) catheter in-situ. He traveled to Egypt to receive a living-related kidney transplant (LRKT) from his aunt after obtaining approval from the Egyptian government. His first 3 months post-LRKT were uneventful. He returned to the USA and established post-transplant care at our institution. Although operative notes were unavailable, the RLQ Gibbon scar of kidney transplantation was visible on exam. There was no external PD catheter, leading to our assumption that the PD catheter was removed entirely which is the usual practice in the USA. 4 months post-transplant, proteinuria (1g/d) was noted and kidney biopsy confirmed recurrence of FSGS. Due to lack of response to antiproteinuric medications, treatment was escalated to plasmapheresis and rituximab. While increasing immunosuppression, he developed mild intermittent lower abdominal pain concerning for infection. CT abdomen/pelvis showed a retained internal PD catheter (Fig. 1). Removal of the catheter resolved his lower abdominal symptoms. Discussion: Our patient followed PTT directives to receive a LRKT. Despite its legal and ethical acceptability, one downside of PTT is limited continuity of care. In the USA, the PD catheter is removed entirely (internal and external). In Egypt, PD is extremely limited, and the surgeons likely left the internal PD catheter in-situ for future use. However, limited documentation caused a delayed diagnosis. This case report highlights the importance of maintaining a high index of suspicion for rare complications, especially in patients who have received transplant through PTT.