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Volume: 15 Issue: 1 February 2017 - Supplement - 1

FULL TEXT

Annual Data for Kidney Transplant Services in Kuwait (2015)

Objectives: Renal transplant services have been provided by the Hamed Al-Essa Organ Transplant Center in Ibn Sina Hospital since 1979 for Kuwaitis and non-Kuwaiti citizens residing in Kuwait. We aimed to monitor the activity and outcome of annual renal transplants in 2015.

Materials and Methods: Data on transplant patients were collected from hospital records from January 1, 2015, through December 31, 2015, at Ibn Sina Hospital.

Results: Eighty-one patients underwent a renal trans­plant in Kuwait in 2015; 46 patients (56.8%) were male and 35 (43.2%) were female. Of these 81 patients, 24 (29.6%) received a kidney from a deceased donor, 19 (23.5%) received a kidney from a living-unrelated donor, and 38 (46.9%) received a kidney from a living-related donor. Thirty-four patients (41.98%) who were highly sensitized immunologically underwent suc­cessful desensitization before transplant according the local protocol; 13 (38.2%) of these patients were male and 21 (61.8%) were female. Two patients (2.47%) experienced acute rejection within the first week after transplant. One diabetic female patient underwent a successful simultaneous deceased-donor kidney and pancreas transplant. Seventy-nine patients who underwent a transplant outside of Kuwait in 2015 were added to the follow-up list; 62 (78%) of these patients were male and 17 (22%) were female. Of these 79 patients, 31 patients (39%) received a kidney from a living-related donor, 45 (57%) received a kidney from a living-unrelated donor, and 3 (4%) received a kidney from a deceased donor. In addition, 303 patients were assessed for fitness for kidney transplant; 204 (67.3%) of these patients were male and 99 (32.7%) were female. Eight (2.6%) patients were not placed on the waiting list for a kidney transplant for medical reasons.

Conclusions: A total of 81 patients underwent a renal transplant in Kuwait in 2015, only 2 (2.47%) of whom experienced acute rejection in the first week after transplant.


Key words : Desensitization, Organ trafficking, Renal transplant

Introduction

At Hamed Al-Essa Organ Transplant Center, members of the Nephrology Department work closely with members of the departments of Transplant Surgery and Immunology, the laboratories, and other ancillary facilities at the Ibn Sina Hospital. This program is considered the largest single-center transplant program in the Gulf region as it is the only center providing such service all over Kuwait. The center performs living-related donor renal transplants, living-unrelated donor renal transplants, deceased-donor renal transplants, and simultaneous pancreas and kidney transplants. The center also provides posttransplant medical care for Kuwaiti and non-Kuwaiti patients who reside in Kuwait but have undergone a renal transplant outside of Kuwait.

Evaluation of prospective renal and pancreatic transplant recipients is performed by members of the nephrology department. Patients are declared medi­cally fit for transplant only after the required inves­tigations have been performed and the opinions of physicians in other specialties have been received, for example, cardiology, and assessments are considered according to local and international guidelines.

In this study, we sought to determine the number and types of kidney transplant services that took place at Hamed Al-Essa Organ Transplant Center during 2015.

Materials and Methods

Data on transplant patients were collected from January 1, 2015, through December 31, 2015, from logbooks, hospital records, patient files, and medical records at Ibn Sina Hospital. Descriptive statistics were performed using Microsoft Excel 2010.

Results

The center assessed 303 patients for fitness for kidney transplant; 204 (67.3%) of these patients were male and 99 patients (32.7%) were female. Eight patients (2.6%) were not placed on the waiting list for kidney transplant for medical reasons (Figure 1).

Eighty-one patients underwent a renal transplant in Kuwait (Figure 2); 24 (29.6%) of these patients received a kidney from a deceased donor, 19 patients (23.5%) received a kidney from a living-unrelated donor, and 38 patients (46.9%) received a kidney from a living-related donor (Figure 3). Of these 81 patients, 46 patients (56.8%) were male and 35 patients (43.2%) were female (Figure 4). Mean age of the patients was 42.1 ± 16.12 years (Figure 5). There were 34 patients (42%) at high immunologic risk due to the presence of high levels of antihuman leukocytic antigen antibodies. One diabetic female patient underwent a successful simultaneous deceased-donor kidney and pancreas transplant. There was only 1 pediatric patient (younger than 15 years at time of transplant). There were 28 transplant recipients (37%) with blood type O positive, 6 recipients (8%) with blood type O negative, 20 recipients (26%) with blood type A positive, zero recipients (0%) with blood type A negative, 11 recipients (14%) with blood type B positive, 1 recipient (1%) with blood type B negative, 8 recipients (11%) with blood type AB positive, and 2 recipients (3%) with blood type AB negative (Figure 6).

Seventy-nine patients who underwent a trans­plant outside of Kuwait in 2015 were added to the follow-up list; 62 (78%) of these patients were male and 17 (22%) were female. Thirty-one (39%) of these patients received a kidney from a living-related donor, 45 patients (57%) received a kidney from a living-unrelated donor, and patients 3 (4%) received a kidney from a deceased donor (Figure 7).

Thirty-six patients who were highly sensitized immunologically with high levels of antihuman leukocytic antigen antibodies underwent desen­sitization per the local protocol. Thirteen (36%) of these patients were male and 23 (64%) were female (Figure 8). Of these 36 patients, 34 patients (94%) successfully completed the desensitization protocol and proceeded to successful renal transplant, which accounts for 41.98% of total transplants; 13 (38.2%) of the 34 patients were male and 21 (61.8%) were female. Of the 36 patients, 1 patient (2.8%) did not complete the desensitization protocol because of personal reasons and the desensitization protocol was unsuccessful for another patient (2.8%).

Delayed graft function was observed in 24 patients (30%) who required dialytic supportive therapy during the first week after transplant; slow graft function was observed in 6 patients (7%); and normal graft function was observed in 51 patients (63%) (Figure 9). Two patients (2.47%) who experienced acute rejection within the first week after transplant were treated successfully with plasma exchange, high-dose intravenous immunoglobulin, and rituximab. The calculated mean length of hospital stay was 13.43 ± 5.73 days (Figure 10).

Discussion

The kidney transplant program at Hamed Al-Essa Organ Transplant Center is one of the largest single-center renal transplant programs in the Middle East and is currently the only center providing renal transplant services in Kuwait. Furthermore, Kuwait is leading the Middle East countries in the number of kidney transplants performed per capita.1

However, the annual number of renal transplant operations performed in Kuwait has been nearly stationary during the past decade, with more emphasis recently over highly sensitized patients (41.98%) with a satisfactory success rate (94%).

At the same time, the number of renal transplants being performed overseas for Kuwaitis is escalating. This growing trend can be attributed to the increasing demand for donor organs due to population growth, while the local availability for both living and deceased organs is plateauing. In addition, deficient measures to counteract organ trafficking in some countries make the process of acquiring a kidney illegally both easy and attractive to many patients.

This widening gap between the numbers of local and overseas transplants being performed is not only an ethical problem, owing to organ trafficking but also a burden on the local health care system owing to the expected high rate of medical and surgical complications resulting from transplants performed overseas.

Conclusions

In 2015, a total of 81 patients underwent a renal transplant in Kuwait. Two patients (2.47%) who experienced acute rejection within the first week after transplant were treated successfully with plasma exchange, high-dose intravenous immunoglobulin, and rituximab.


References:

  1. Masri, MA, Haberal MA, Shaheen FA, et al. Middle East Society for Organ Transplantation (MESOT) transplant registry. Exp Clin Transplant. 2004;2(2):217-220.
    PubMed


Volume : 15
Issue : 1
Pages : 28 - 31
DOI : 10.6002/ect.mesot2016.O18


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From the 1Nephrology Department, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Kuwait; and the 2Transplant Surgery Department, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Kuwait
Acknowledgements: The authors declare that they have no sources of funding for this study, and they have no conflicts of interest to declare.
Corresponding author: Yahya M. Makkeyah, Nephrology Department, Hamed Al-Essa Organ Transplant Center, Ibn Sina Hospital, Sabah Health District, Kuwait
Phone/Fax: +965 69 003 554
E-mail: ymakkeyah@gmail.com