| Abstract|| |
The Southern Region renal transplant program was established in February 1989. The appointment of a transplant co-ordinator and creation of a waiting list for the Southern Region as well as tissue typing of all patients in the region were important early steps. Between February 1989 and December 1995, 155 transplants were performed on 152 patients at the Armed Forces Hospital, Southern Region (AFHSR). Of them, 52 were cadaveric donor transplants and the remaining were from living related donors. The overall five-year actuarial patient and graft survival was 93% and 78% respectively. Of the 152 patients who were transplanted, 79 patients were from other hospitals in the region and 73 were from AFHSR. Maintenance immunosuppression consisted of cyclosporin, azathioprine and prednisolone. Use of the spouse as a donor was an early feature of this program. Our results compare favorably with results published from other centers. To cope with the increasing demand of transplantation in the Southern Region, we have to look into ways of increasing our transplant numbers to match the needs.
Keywords: Renal transplantation, Saudi Arabia, Graft survival, Patient survival.
|How to cite this article:|
Mohammed AS, Al-Hashemy A, Addous AJ, Ismail G. The Southern Region Renal Transplant Program at Armed Forces Hospital, Khamis Mushayt. Saudi J Kidney Dis Transpl 1996;7:164-7
|How to cite this URL:|
Mohammed AS, Al-Hashemy A, Addous AJ, Ismail G. The Southern Region Renal Transplant Program at Armed Forces Hospital, Khamis Mushayt. Saudi J Kidney Dis Transpl [serial online] 1996 [cited 2020 Feb 21];7:164-7. Available from: http://www.sjkdt.org/text.asp?1996/7/2/164/39520
| Introduction|| |
The Southern Region of the Kingdom of Saudi Arabia, with a population of approximately two million people, has 679 patients on maintenance hemodialysis in 18 facilities scattered all around the region. An average of 173 new patients is started on dialysis each year in this region (Saudi Center for Organ Transplantation (SCOT) data. With the help of SCOT, a regional transplant program was started in February 1989. The objectives of the program [Table - 1] clearly defined and a transplant coordinator was appointed at the start of the program. His role kept expanding with the progress of the program [Table - 2]. The first living related transplantation was performed on February 15, 1989 with the help of a surgical team from the Royal Liverpool Hospital (U.K.). The first cadaveric transplantation was performed on July 21, 1989 with the help of a surgical team from the Riyadh Armed Forces Hospital. Since 1990, the staff of the Armed have independently run the program.
| Patients and Methods|| |
The organization of the program was published in 1992  . Creation of a waiting list and having tissue typing data of all patients suitable for renal transplantation was an early step. Currently, around 300 patients are on the waiting list. These patients were seen initially in the transplant center where all relevant investigations were completed after detailed physical examination and a decision taken whether or not the patient should be on the waiting list. On this visit, the exact address of the patient was noted and a way of contacting the patient as and when he/she is needed for a transplant was established. This visit also allowed the introduction of the patient to the staff at the transplant center.
Between February 1989 and December 1995, 155 renal transplantations were performed on 152 patients at AFHSR [Table - 3]. The mean age of the patients was 37 years, range 10-70 years. Of them, 79 patients were from other hospitals in the Southern Region and 73 patients were from AFHSR. A total of 101 patients had living related donor transplants of whom 53 received donor specific transfusions (DST) prior to transplantation. The protocol of DST was published in 1993  . The use of the spouse as a donor is one of the highlights of our LR program  . Fifty four transplants were from cadaveric (CAD) donors [Table - 4].
Maintenance immunosuppression consisted of cyclosporin, azathioprine and prednisolone. Diabetic patients as well as those who developed steroid-induced diabetes mellitus were put on cyclosporin and azathioprine only, as early as possible. HLA-identical transplants were treated with prednisolone and azathioprine. Rejection episodes were treated with intravenous methyl prednisolone. Anti-thymocyte globulin (ATG) was used for steroid-resistant rejection.
| Results|| |
The overall five-year actuarial patient and graft survival was 93% and 78% respectively [Figure - 1]. In LR transplants, patient survival was 93% and graft survival, 85% at five years. The patient and graft survival rates in CAD transplants were 94% and 74% respectively. Seven of the 101 patients who had LR transplant died. One died in the immediate post-operative period due to cardiogenic shock, two died three months after transplantation; one due to CMV infection and the second committed suicide. Two patients died of meningo-encephalitis of unknown cause, one died in another regional hospital, and one patient died in another country.
A total of 15 LR grafts were lost, seven due to death of the recipient, three due to primary non-function, one each due to Kaposi's sarcoma, and non-compliance to treatment and three others due to mesangiocapillary glomerulonephritis. We could not determine whether the latter was de-novo or recurrent disease, as the original renal disease in the patients was not known.
Among recipients of CAD transplants, there were three deaths. One died of Listeria meningo-encephalitis and Kaposi's sarcoma, one due to pulmonary embolism and the third due to cardiac arrest during a rescue transplantation. This patient had superior vena caval obstruction, thrombosis of both iliac veins and had lost her CAPD catheter due to fungal peritonitis. Also, she had not received any dialysis for ten days prior to transplantation. The graft vessels of this patient had to be anastomosed to the aorta and the inferior vena cava.
Fourteen grafts were lost, three due to death of the recipient, six due to primary non-function and two each due to graft renal artery stenosis and irreversible acute rejection. One patient left the country and no further information was available. The current functioning graft status is shown in [Table - 5].
| Discussion|| |
The transplant program in the Southern Region has progressed favorably over the past few years [Table - 3]. We are fortunate to have results that compare favorably with figures that were presented by the European Renal Association and The European Dialysis and Transplant Association in Athens in June 1995. It is essential to increase the number of transplants performed, in the region and this view is shared by SCOT. In order to achieve this, we have to intensify our campaign towards increasing public awareness about the benefits of organ donation and use the supportive role of Islam for donation. The information media should play a very supportive role and social groups like hospital friends should help in the discussions about brain-death and organ donation. Education of hospital staff about brain-death and reporting of brain-dead patients, and looking into ways of rewarding hospitals with best results might help increase the cadaveric retrieval rate not only in the region but also in the Kingdom as a whole.
| Acknowledgements|| |
We are grateful to Dr. N. Velasco and Mr. J. Maynard who started the program in 1989, to Mr. S. Barker and Dr. P. Little who worked in the program, to Dr. P. Harrison, Chief of Nephrology for reviewing the manuscript, and to the expert secretarial help of Mrs. Elizabeth Wilson.
| References|| |
|1.||Mohamed AS, Velasco N. The Southern Region Renal Transplant Program, Kingdom of Saudi Arabia. Saudi Kidney Dis Transplant Bull 1992;3:142. |
|2.||Mohamed AS, Hassan S, Velasco N, Barker S, Ismail J. Al-Hashemy A. Four years experience of donor specific transfusion (Abstract). Saudi Kidney Dis Transplant Bull 1993;4(3):97. |
|3.||Mohamed AS, Hassan S, Barker S, Ismail J, Al-Hashemy A. The use of the spouse as an alternative to genetically related donor (Abstract). Saudi Kidney Dis Transplant Bull 1993;4(3):S95. |
Abdalla Sidahmed Mohammed
Armed Forces Hospital, Southern Region, P.O. Box 101, Khamis Mushayt
[Figure - 1]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]