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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2006  |  Volume : 17  |  Issue : 2  |  Page : 222-229
Attitude of Transplant Centers in the Middle East Towards the Follow-up of Renal Allograft Live Donors


Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia

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   Abstract 

In an attempt to survey the attitude of the heads of some distinguished transplant programs in the Middle East countries towards the follow-up and complications that may ensue in the live renal allograft donors, we sent a questionnaire to 29 active renal transplant centers in the Kingdom of Saudi Arabia (KSA) and some other Middle East countries, which together perform about 1500 living renal transplantations annually. The study was performed during November-December, 2005. The questionnaire was intended to evaluate the presence of a protocol that guides the physicians in their selection, work-up and follow-up of the live renal allograft donors, the presence of regular time schedule for follow-up of the donors during the first year and thereafter, and the tests performed during these clinic visits, the physicians' perception towards the life-long health insurance of the live donors as well as the physicians' estimates of the major complications that may occur in the live donors such as hypertension, proteinuria, chronic renal failure, early surgical complications and depression. There were 20 responses (69%) from transplant centers that together perform about 1200 (80%) living renal transplantations annually. There were 18 (90%) respondents who had a protocol to guide the selection of the live renal allograft donors, 10 (52.6%) had a written policy for post-donation follow-up of live renal allograft donors, 15 (83.3%) would see the donors for the first time within three months post-discharge, 10 (66.7%) would see the donors every three months thereafter during the first year and 11 (68.8%) would see them once a year after the first year. There was a consensus among the respondents to monitor the renal function tests that include plasma urea creatinine and urinalysis. The post donation incidence of hypertension, proteinuria, chronic renal failure, early surgical complications and psychological problems such as depression was estimated by more than 80% of the respondents as 1-5%. We conclude that the current practices concerning the follow-up of renal allograft live donors by the dialysis centers in the Middle East seem promising. However, this being a questionnaire survey, results may not be totally accurate. Prospective studies are required to ensure that protocols for follow-up are abided by.

Keywords: Renal, Transplantation, Donors, Saudi, Middle East, Complications.

How to cite this article:
Souqiyyeh MZ, Shaheen FA. Attitude of Transplant Centers in the Middle East Towards the Follow-up of Renal Allograft Live Donors. Saudi J Kidney Dis Transpl 2006;17:222-9

How to cite this URL:
Souqiyyeh MZ, Shaheen FA. Attitude of Transplant Centers in the Middle East Towards the Follow-up of Renal Allograft Live Donors. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2020 Jun 5];17:222-9. Available from: http://www.sjkdt.org/text.asp?2006/17/2/222/35795

   Introduction Top


Surveys of the attitudes of physicians toward their practices in the transplant centers are one of the tools to evaluate the quality care provided to the renal allograft live donors.[1],[2],[3]

Renal transplantation is an established modality of therapy for end-stage renal disease (ESRD).[4],[5],[6],[7] The growing importance of live renal allograft donation is evident from the observation that it has exceeded in number, donation from the deceased, in Europe and the United States of America (USA).[8],[9]

The American Society of Transplantation and the European Renal Association (European Best Practice of Transplantation) have laid down the guidelines regarding the selection and evaluation of live renal allograft donors. [4],[5],[6],[7] The goals and means of therapy are defined according to the best evidence available from the medical literature. These guidelines have emphasized the proper evaluation and follow­up of the live donors. Moreover, many studies from different regions of the world such as Europe, [10],[11],[12],[13],[14],[15],[16] USA, [17],[18],[19],[20] Canada, [21] Mexico [22] and Asia [23],[24],[25],[26],[27] have advocated long-term follow-up of the live donors to look for possible complications.

There is a growing concern about the health and outcome of the live kidney donors world­wide. Recently, the World Health Organization (WHO) has issued a resolution about the protection of the welfare of the donors and prevention of the exploitation of the poor.[28] Live renal allograft donation is for all practical purposes the only source for renal transplant­ation in the Middle East countries, which increases the concern even more, about the outcome of the live donors.[29]

The aim of this study is to survey the attitude of the heads of distinguished transplant programs in the Middle East countries towards the follow-up and complications that may ensue in the live renal allograft donors


   Materials and Methods Top


We sent a questionnaire to 29 Heads of active renal transplant centers in the Kingdom of Saudi Arabia (KSA) and other Middle East countries, which together perform about 1500 living donor renal transplantation annually. The questionnaire was mailed to the targeted physicians during October 2005 and responses were received at the Saudi Center for Organ Transplantation (SCOT), Riyadh, KSA during November-December, 2005.

The questionnaire was intended to evaluate the following aspects in the practice of physicians who take care of the renal allograft live donors:

a) The presence of a protocol that guides the physicians in their selection, work-up and follow-up of the renal allograft live donors.

b) The presence of regular time schedule for follow-up of the donors during the first year and thereafter, and the tests performed during these visits, such as blood glucose and renal function tests, urinalysis and 24-hour urine protein, complete blood count and ultrasound of the remaining kidney and/or isotope renal scan.

c) The physicians' perception towards the life-long health insurance of the live donors.

d) The physicians' estimates of the major complications that may occur in the live donors according to the current experience of the transplant centers. The complications include hypertension, proteinuria, chronic renal failure, ESRD, early surgical com­plications and psychological complications such as depression.

We considered the best answers as those in accordance with the common denominator of the established guidelines and practices in the USA [4],[5] and Europe [6],[7] that include:

a) A recommendation for careful selection of the donors based on specific inclusion and exclusion criteria.

b) A recommendation for long-term follow­up of the donors and regular clinic visits with special attention to the post-donation complications.


   Statistical Methods Top


Data were entered in a Microsoft Excel file and the description of the data and their analyses were done by using the statistical program, SPSS.


   Results Top


There were 20 responses out of the 29 (69%) transplant centers; these 20 centers perform about 1200 (80%) living donor renal transplantations annually.

[Table - 1] shows the answers related to the current status of having organized follow­up of the live renal allograft donors in the transplant centers There were 18 (90%) respondents who had a protocol to guide the selection of the live renal allograft donors, 10 (52.6%) had a written policy for post­donation follow-up of live renal allograft donors, 15 (83.3%) would see the donors for the first time within the three months post­discharge from the hospital, 10 (66.7%) would see the donors every three months thereafter during the first year and 11 (68.8%) would see them once a year after the first year. Thirteen (65.0%) respondents believed the strict follow-up schedule for the live renal allograft donors was necessary in all the donors. Eighteen (94.7%) respondents agreed that life-long health insurance should be offered to the live renal allograft donors.

[Table - 2] shows the laboratory monitoring of the live renal allograft donors post-donation. All the respondents answered the questions related to the laboratory follow-up of the donors. There was a consensus among the respondents to monitor the renal function tests that included plasma urea, creatinine and urinalysis as well as certain other tests including complete blood count and plasma glucose. However, only two thirds would perform routine 24-hour urinary protein measurement and creatinine clearance and, 11 (55.0%) would obtain a renal ultrasound and/or isotope renal scan routinely post­donation.

[Table - 3] shows the estimated incidence of the short and long-term complications in the live renal allograft donors. The related questions were answered by 80-85% of the respondents. The post-donation incidence of hypertension, proteinuria, chronic renal failure, early surgical complications and psychological problems such as depression were estimated to be 1­5% by more than 80% of the respondents.


   Discussion Top


The current study attempted to detect the attitude of the physicians in charge of the renal transplantation centers in the KSA and Middle East towards the post-donation follow­up of live renal transplant donors.

The results of this study show good practices, compatible with the practice guidelines in the USA and Europe. [4],[5],[6],[7] The great majority of the respondents had a protocol to guide the selection of the live renal allograft donors and would see the donors frequently after donation to evaluate for the rare complications that might occur in them. The majority of the respondents believed that strict follow­up schedule was necessary in all the donors. Furthermore, almost all the respondents agreed that life-long health insurance should be offered to the live renal allograft donors. Many studies suggested such a strategy. [30],[31],[32],[33],[34]

There was a consensus on the basic laboratory monitoring for the donors. However, fewer respondents would routinely perform regular 24- hour urine collections for monitoring proteinuria as well as renal ultrasound and/ or isotope scan. Many previous reports have emphasized the importance of laboratory follow-up tests including a renal ultrasound. However, isotope renal scan may not be necessary as a routine test.[10],[12],[21],[35],[36],[37],[38],[39]

One important practice, however, reflected a lag in the optimal application of the guide­lines. This was the lack of having a written policy for post-donation follow-up of live renal allograft donors as seen in half of the centers of our survey. A clear policy has been advocated by many reports.[13],[15],[17],[40],[41],[42],[43]

The main complications after live renal allograft donation include hypertension, proteinuria, chronic renal failure, early surgical complications and psychological problems such as depression. In our survey, the reported incidence for all these complications was low.

Many studies have reported an incidence of hypertension, post-renal donation to be from 1 to 38%. [10],[12],[18],[23],[24],[38],[44],[45],[46],[47],[48],[49],[50] However, the hypertension was mostly of mild degree and probably related to increased age of the donors. Interestingly, the incidence was lower than the incidence in the general population.

The incidence of proteinuria has been reported to be from 19-56% for proteinuria <1 g/ day and 2-6% for proteinuria >1 g/day. Furthermore, the proteinuria was associated mostly with hypertension, hyperfiltration in the remaining kidney or de novo renal disease. [10][,14],[18],[23],[24],[36],[37],[38],[40],[48],[49],[50],[51] Although we did not differentiate between the light and heavy proteinuria in our survey design, the range of incidence in the literature was higher than that in our survey.

The reported incidence of chronic renal failure in the live renal allograft donors in other studies was not too different from the estimates in our survey. [12],[23],[24],[36],[38],[46],[47],[49],[50],[52],[53].

The reported incidence of the surgical and medical perioperative complications in the live renal allograft donors is between 5-7% and mostly minor related to the wound such as persistent pain at the site of the incision. [10],[46],[54],[55] Our respondents had similar estimates. Depression occurred in a low percentage of the donors in previous studies similar to the estimated incidence by the respondents in our survey. Almost all the donors usually find the donation satisfying and gratifying. [10],[19],[27],[39],[56],[57]

We conclude that the current practices concerning the selection and follow-up of live renal allograft donors in the KSA and other Middle East countries are mostly satis­factory. However, our report is a questionnaire­based survey, which carries many limitations. As such, comparing the estimated incidence in our survey with reports published earlier may at best, be approximate. This is com­pounded by the observation that not all queries are answered by all respondents, thus making statistical analysis that much more complicated. Despite these limitations, we hope this survey will serve as a forerunner to many studies on this vital subject from the Middle East. If this can be achieved, as also having a written policy in the transplant centers for the follow­up of the donors as mentioned in literature, we believe that our efforts were not in vain.


   Acknowledgement Top


We would like to thank Novartis pharma­ceuticals, Saudi Arabia for their grant that made this study possible. Also, the authors would like to thank the heads of the parti­cipating transplant centers as in [Table - 4] for their time spent in filling the questionnaire:

 
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Correspondence Address:
Muhammad Ziad Souqiyyeh
The Saudi Center for Organ Transplantation, P.O. Box 27049, Riyadh 11417
Saudi Arabia
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