Living Unrelated Renal Transplant: Outcome and Issues

• Main Authors: Al-Wakeel Jamal, Mitwalli Ahmed, Tarif Nauman, Malik Ghulam, Al-Mohaya Sulaiman, Alam Awatif, El Gamal Hazem, Kechrid Mohammed
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2000-01-01
• Series: Saudi Journal of Kidney Diseases and Transplantation
• Subjects: Kidney transplant; Living unrelated donors; Complications; Survival.
• Online Access: http://www.sjkdt.org/article.asp?issn=1319-2442;year=2000;volume=11;issue=4;spage=553;epage=558;aulast=Al-Wakeel

Living unrelated transplantation (LURT) is emerging as a practical option in renal transplantation due to shortage of living related and cadaver donors. We report a six-years (December 1991 to December 1996) follow-up of 60 LURT patients. The majority of these patients (95&#x0025;) were transplanted outside the Kingdom of Saudi Arabia; 37 in India, 14 in Egypt, five in the USA and one in Pakistan. Only three patients (emotionally related) were transplanted in Saudi Arabia. Before transplantation, 50 (83.4&#x0025;) patients were on chronic hemodialysis, three (5&#x0025;) on peritoneal dialysis and three (5&#x0025;) were transplanted pre-emptively. Post-operatively, the majority of the study patients were on three drug immunosuppressive therapy. One and five year graft survival was 93.0&#x0025; and 59.6&#x0025;, while patient survival at one and three years was 93.7&#x0025; and 81&#x0025;, respectively. Surgical complications included lymphocele in 10&#x0025; of the study patients, urinary leak in 8.3&#x0025;, and bleeding from the vascular anastomosis in 6.6&#x0025;. There were eight episodes of acute rejection in eight (13.3&#x0025;) patients and all episodes were successfully treated; two patients required monoclonal anti-lymphocyte antibodies (OKT3). Eleven (18.3&#x0025;) patients developed chronic rejection, which resulted in the loss of ten (90&#x0025;) allografts. Infection was the commonest cause for hospital admission; urinary tract infection (UTI) being responsible for 40&#x0025; of admissions. Three patients had <i>Cytomegalovirus </i>pneumonia, one had <i>Pneumocystis Carinii </i>pneumonia and one had candida pneumonia. Two <i>(3&#x0025;) </i>patients developed Kaposi&#x2032;s sarcoma. We conclude that LURT can help in overcoming the shortage of organs for transplant, however, commercial transplantion in developing countries is associated with high morbidity and mortality.