| Abstract|| |
Renal transplantation is considered the optimal form of renal replacement therapy for patients with end stage renal disease. Kidney transplantation was started in Iraq in 1973 at Al-Rasheed military hospital after Jordan in 1972 and Lebanon in 1973. In this study we analyze retrospectively the data of (182) kidney recipient patients selected randomly from 1979 to 1999, including (165) male and (17) female patients. Their age ranging from 18 to 54 years and the follow up period was 0 to 240 months postoperatively. The average duration of dialysis before transplantation was 4 to 5 months. The donors in most instances were live related (89.6%). The immunosuppressive imereg include both double and triple therapy and all episodes of rejection were treated with pulse methyl prednisolon. The patient survival rates at 1, 5 and 10 years were 82.9%, 79.7%, and 71.2% respectively while the graft survival rate at 1, 5 and 10 years were 83.5%, 64.5% and 61.6% respectively. These results were found to be comparable to the average values of Arab countries reported in the survey of Arab Society of Nephrology & Renal Transplantation (ASNRT) in 1999. All the medical and surgical complications encountered in our series are described and discussed and the effect of sanction imposed on Iraq is clarified.
Keywords: Kidney transplantation, Long term complications, Iraq.
|How to cite this article:|
Sh. Al-Taee IK, Al-Shamaa I. Long Term Follow-Up of Renal Transplant Patients-a Single Center Experience in Iraq. Saudi J Kidney Dis Transpl 2005;16:40-5
|How to cite this URL:|
Sh. Al-Taee IK, Al-Shamaa I. Long Term Follow-Up of Renal Transplant Patients-a Single Center Experience in Iraq. Saudi J Kidney Dis Transpl [serial online] 2005 [cited 2020 Feb 24];16:40-5. Available from: http://www.sjkdt.org/text.asp?2005/16/1/40/32950
| Introduction|| |
End stage renal Failure is a common problem encountered worldwide. Its incidence ranges from 100 to 120 patients per million population per year (PMP). Renal transplantation is considered to be the optimal form of renal replacement therapy (RRT) for ESRD with an average of 2.2 PMP in the Arab World. ,,
The first successful human kidney transplantation was done in 1954 in Boston & the allograft was from an identical twin. Renal transplantation started to become a routine practice in 1960's.
According to the survey of the Arab Society of Nephrology & Renal Transplantation (ASNRT) kidney transplantation had been started in Arab world in Jordan in 1972  followed by Lebanon in 1973, while in Iraq active kidney transplantation program was started in 1973 at Rasheed military hospital. Since then the transplantation is being successfully done in many centers in Iraq.
Our aim in this study was to analyze retrospectively our experience in Al-Rasheed renal center in Baghdad in the follow up of kidney transplant recipients.
| Patients & Methods|| |
The data of 182 kidney recipients during the period from 1979 to 1999 in Al-Rasheed center had been selected & analyzed retrospectively. This included 165 males (90.66%) & 17 (9.34%) females. The age of the patients at the time of transplantation ranged from 18 to 54 years. The follow up period after transplantation ranged from 0 to 240 months with an average of 120 months.
The average duration of dialysis before renal transplantation was 4 to 5 months. 163 (89.6%) of the donors were live related (LRD) while 14 (7.7%) were live unrelated (LURD) and only 5 (2.7%) were live emotionally related donors (LERD) including spouses and breast milk relatives.
The immunosuppression induction regime was double therapy in 120 (65.9%) patients (including prednisolon and azathioprine or cyclosporine) & triple therapy (prednisolone, azathioprine & cyclosporine) in 62 (34.1%) patients. Monotherapy was occasionally used. All acute rejection episodes were diagnosed on clinical grounds and treated with pulse methylprednisolon injection (MP).
| Results & Discussion|| |
Worldwide, the success of renal transplantation is measured by the long term graft function. The survival rate from renal transplantation have improved over the last two decades due to improvement in immunosuppressives, surgical techniques, anesthetics, diagnostic techniques leading to expansion of the kidney recipient pool.  Of our recipients, 13.7% were returned to dialysis while only seven recipients (3.9%) got double grafts.
Using ANOVA (analysis of variance), there was no significant difference in the serum creatinine level between the patient on double & triple therapy and between patients with LRR, LURR, and LER recipients.
The actuarial patient survival rate at one, five and ten years in our series were 82.9%, 79.7%, & 71.2% respectively, While the actuarial graft survival rate at one, five and ten years were 83.5%, 64.5% and 61.6% respectively [Figure - 1].
ASNRT, in 1999, reported the average graft survival rates in Arab countries to be 87%, 80%, 60%, and patient survival rates to be 96%, 85%, 70% at one, five and ten years respectively  [Figure - 2] and [Figure - 3].
Both figures (2 and 3) are comparing our results with that of ASNRT survey. There is no significant differencse in the graft survival rates at one and ten years but there is significant difference at five years only [Figure - 2]. Concerning patient survival rate, there is significant difference at one year while no significant differences at five and ten years [Figure - 3] were seen. The graft and patient survival rates at ten years were more or less similar to the average of that of ASNRT survey.
We also studied the effects of the economic embargo on the actuarial graft & patient survival rates in our series. Two groups of recipients were selected randomly, each composed of 30 recipients; one from 1980 - 1985 (group - A) and the other from 1990 - 1995 (group - B). One and five years graft and patients' survival rates of both groups were studied [Table - 1] and compared to each other. No significant difference was found between the two groups concerning the actuarial patient survival rate [Figure - 4] while a significant difference was found in the actuarial graft survival rate (P < 0.05) [Figure - 5]. This may be the effect of embargo in leading to severe shortage of immunosuppressives & antibiotics this led to stopping of drug intake. 48 of our recipients (46.2%) died during a period from 1-108 months after transplantation. The most common causes of death were; acute rejection (44%), chronic rejection (21%), sepsis (12%) & CVDs (7%) [Figure - 6].
[Table - 2] shows the most common early medical complications in our series. Hypertension was seen in 95 (52.2%) recipients. It developed after 1-6 months after transplantation in most patients and is multifactorial in causation.  Acute rejection was seen in 68 (37.4%) recipients in the first month of transplantation. Acute UTI was seen in 65 (35.7%) recipients mostly after the first month. Chronic nephropathy was seen in 26 (14.3%) recipients mostly after six months of transplantation while ESRD occurred in only 18 (9.9%) recipients after six months also.
Other less common late medical complications encountered in our series are listed in [Table - 3]. Pneumonia is still the most common type of chest infection (9.3 %) and tuberculosis constituted (3.3%) of which (2.8%) is pulmonary TB and (0.5%) is laryngeal TB. The TB incidence in our series is found to be similar to that reported in Saudi Arabia (3.1-4.4 %). 
The prevalence of HBV & HCV looks underestimated in this study because the program of screening and vaccination against HBV & HCV were introduced in Iraq only in late 1990s because of the sanctions. So the possibility of preexisting infection before transplantation can't be excluded.
The rate of malignancy in our series was (5.5 %) which is similar to that reported in the literature.  [Table - 4] lists the types of malignancies encountered in our recipients. Concerning fertility, two female patients had got successful pregnancies and nine male patients fathered 1 to 4 children postoperatively.
The common surgical complications encountered in our series are listed in [Table - 5] Wound infection and urinary leak were the most common and this is similar to that reported in the literatures. 
| Conclusion|| |
We would like to highlight that despite serious complications encountered especially in the early phases after transplantation and despite the effects of prolonged sanctions on Iraq, it was possible to achieve an acceptable outcome similar to the average rate of the Arab world reported by ASNRT survey.  We are hoping to have a chance to begin with cadaveric transplantation program in Iraq as soon as possible. Moreover, to our knowledge, this study is the first ten years based followup study of kidney transplant patients in Iraq.
| References|| |
|1.||EDTA report on management of renal failure in Europe XXIV, 1993. Nephrol Dial Transplant 1995;10 Suppl:5. |
|2.||Suliman SM, Belielo MH, Hamza H. Dialysis and transplantation in Sudan. Saudi J Kidney Dis Transplant 1995; 6(3):312-4. |
|3.||Shaheen FAM, Souqiyyeh MZ. Survey of the current status of renal transplant-ation in the Arab Countries. Saudi J Kidney Dis Transplant 1998;9(2):123-7. |
|4.||Laskow DA, Curtis JJ. Post -transplant hypertension. Am J Hypertens 1990; 3(9):721-5. |
|5.||Qunibi WY, Al Sibai B, Al Furyah MO. Mycobacterial infection following replantation. Ann Saudi Med 1988;8(6):512 A . |
|6.||Penn I. The incidence of malignancies in transplant recipients. Transplant Proc 1975; 7:323- 6. [PUBMED] |
|7.||Al-Khader AA, Dhar JM, Al Sulaiman MH. Renal transplantation in the Kingdom of Saudi Arabia: A look back at the first decade. Saudi Kidney Dis Transplant Bull 1990;1:63-8. |
Iqdam K Sh. Al-Taee
Rasheed Kidney Transplant Center, Al-Rasheed Military Hospital, Elwiya – P.O. Box: 3712, Baghdad
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]