Patients returning to peritoneal dialysis after renal allograft loss are an increasing segment of the end-stage renal disease population. Non-transplant nephrologists will be managing the short- and long-term complications of chronic immunosuppression in these patients. In this case report, the use of sirolimus is described in a patient who developed a significant peritoneal dialysis catheter exit-site leak delaying the initiation of dialysis. The risk of impaired wound healing at the time of peritoneal dialysis catheter implantation must be considered when bridging patients from transplantation to peritoneal dialysis. Particular caution should be paid to the use of sirolimus during this period.