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RENAL DATA FROM THE ARAB WORLD |
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| Year : 2010 | Volume
: 21
| Issue : 2 | Page : 359-362 |
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| Kidney transplantation in Erbil, Iraq: A single-center experience |
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Pishtewan H Al-Bazzaz
Hawler Medical University, Erbil, Iraq
Click here for correspondence address and email
| Date of Web Publication | 9-Mar-2010 |
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 Abstract | | |
Kidney transplantation is associated with improved quality of life and better survival among patients with end-stage renal disease. The aim of this study is to assess the experience of kidney transplant program in a single center in Erbil, Iraq. The records of 83 pairs, donors and recipients, treated with kidney transplantation at the Zheen Hospital in Erbil, over a two-year period were collected and analyzed. The mean donor age was 28.5 ± 7.34 years (range 19-49 years) and recipient age was 37.6 ± 14.9 years (range 12-66 years). The male to female ratio was 6.5:1 among donors and 3.2:1 among recipients. Among the 83 pairs studied, the donors and recipients were genetically related in seven cases (8.5%) and emotionally related in one case (1.2%). Delayed graft function was seen in 3.2% of cases and acute rejection in 5.3% of cases. Graft survival at six months was 88% while patient survival at the same period was 90%. In conclusion, even though experience related to kidney transplantation in Erbil is limited, the reported results are encouraging for a promising future.
How to cite this article:
Al-Bazzaz PH. Kidney transplantation in Erbil, Iraq: A single-center experience. Saudi J Kidney Dis Transpl 2010;21:359-62 |
| Introduction | |  |
Renal transplantation is the treatment of choice for most patients with end-stage renal disease (ESRD). It improves the quality of life and increases survival rates. Also, it is more costeffective, especially when compared with hemodialysis, the conventional treatment modality for ESRD. Current advances in renal transplantation have resulted in better graft and patient survival, and the improved quality of life has made renal transplantation a favored option for patients with ESRD. [1],[2]
Shortage of organs is an important problem in kidney transplantation. In order to overcome this problem, many countries have initiated living unrelated donor programs through donation from emotionally related persons, friends, and other volunteers. [1],[2]
Iraq was one of the first Arab countries to start kidney transplantation. However, the long years of wars and embargo had tremendous effect on the transplantation activities in Iraq. Before the war in 2003, there were four transplantation centers in Baghdad. However, only two of these are now operating, although irregularly, due to the poor security situation. Transplantation activity has been restored in Erbil since December 26, 2006 providing treatment for patients from all over Iraq. [3],[4] The aim of this study is to conduct an initial assessment and report the experience of the kidney transplant program in a single center in the Erbil governorate in Iraq.
| Patients and Methods | | |
The records of 83 pairs, donors and recipients, treated with kidney transplantation at the Zheen Hospital in Erbil, Iraq between November 26, 2006 and September 25, 2008 were collected and analyzed. Data collected included age, gender, medical history, treatment outcome and complications of the study sample.
| Results | | |
The mean age ± SD of the donors was 28.5 ± 7.34 years (range 19-49 years). The age distribution of the donors showed the highest frequency in the age-groups 21-25 and 26-30 years, 25.3% in each group. The mean age ± SD of recipients was 37.6 ± 14.9 (range 12-66 years). There was no major difference in the distribution of recipients in the different age-groups [Table 1].
The majority of donors were male (86.8%) with a male to female ratio of 6.5:1. Similarly, majority of the recipients were male (75.9%) with a male to female ratio of 3.2:1. [Table 2] shows the gender difference in the donors as well as the recipients.
Most of the donors (96.4%) were from outside the Iraqi Kurdistan region, distributed among different governorates of Iraq. Among the recipients, 45.8% were from Kurdistan and 54.2% were from other parts of Iraq [Table 3].
The highest proportion of both donors and recipients were of blood group O+, 48.2% and 43.4%, respectively. This was followed in frequency by blood group B+ and A+ [Table 4]. Among the 83 pairs studied, the donors and recipients were genetically related in seven cases (8.5%) and emotionally related in one case (1.2%).
The main cause of ESRD was glomerulonephritis with hypertension, seen in 63% of cases. The mean duration of hospital stay for recipients was 7.6 ± 1.44 days (range 4-12 days). Among the recipients, 94% had left to right kidney transplant while 4% had right to left kidney transplant.
Six of the donors tested positive for cytomegalovirus infection and two were positive for toxoplasmosis. On the other hand, five recipients tested positive for cytomegalovirus infection and two were positive for toxoplasmosis.
The immunosuppression regimen followed was methylprednisolone, mycophenolate mofetil (MMF) and cyclosporine while the maintenance therapy comprised of cyclosporine and MMF. Delayed graft function was seen in 3.2% of cases and acute rejection in 5.3% of cases. Graft survival at six months was 88% while patient survival at six months was 90%.
| Discussion | | |
The kidney transplant program in Erbil is a relatively new experience that has been established through the hard work and enthusiasm of local experience utilizing the limited existing resources and support. However, this experience provided the opportunity for many patients from all parts of Iraq to seek treatment at this center. In earlier days, Iraqi patients who needed kidney transplantation had to travel abroad to seek such treatment with the associated difficulties they had to face, whether financial or those related to travel, visa acquisition, etc.
During the two years of experience in Erbil, the general attitude towards kidney transplantation has seen a considerable change with more families willingly coming forward for organ donation. There has been a steady increase in the number of patients and a further steady increase is expected over the following years.
The study revealed a higher proportion of male patients seeking transplantation treatment than female patients. The proportion of male donors to female donors is very high. These differences are probably related to the prevailing socio-cultural factors in the region. However, with time and more experience, these differences may disappear.
The availability of donors remains a real challenge in transplantation. While a genetically suitable donor might not be available in most instances, there is always the opportunity to receive a kidney from an unrelated donor like emotionally related or other strongly motivated donors. It should be kept in mind that the special situation prevailing in Iraq might encourage emergence of commercial donors and therefore, appropriate measures should be taken to prevent commercialization of kidney donation. [1],[3] At this stage, there is an urgent need to develop laws and guidelines by the Government and the local professional associations to prevent emergence of wrongful practices. The success of transplantation as a life-saving treatment should not victimize the poor as the source of organs for the rich. [5]
The results in this study in terms of incidence of delayed graft function of 3.2%, acute rejection of 5.3% and graft survival of 88% are comparable to studies from other countries. [2],[4],[6]
Introduction of cyclosporine has revolutionized the practice of solid organ transplantation. Cyclosporine-based regime was used in our transplant patients, since it is associated with improving both early and long-term graft survival and having long-term benefits for the patients. [7]
The long-term renal consequences of kidney donation by a living donor are attracting increased, but appropriate, interest. A number of studies have suggested that living kidney donors have similar survival rates to that of non-donors and that their risk of ESRD is not increased. Most donors preserve glomerular filtration rate, normal albumin excretion, and an excellent quality of life. [8] However, other studies have observed that the quality of life of donors may be low and they may be at risk of experiencing more stressful life events. Therefore, health care administration should continue after donation and compensate for mental health and psychosocial problems as well. [9]
Cytomegalovirus is considered the most important infectious cause of mortality and morbidity in organ transplant recipients. A recipient who is negative for the anti-cytomegalovirus IgG antibody and receives an allograft from a positive donor, has greater chance of developing cytomegalovirus disease and poorer patient survival. As several cases of cytomegalovirus-positive cases were found among the donors and the recipients, close monitoring of cytomegalovirus-positive patients and the use of less-intensive immunosuppressive treatments are recommended. [10]
The lack of resources, especially those of sensitive methods to detect preformed antibodies in the recipient serum and the lack of HLA-matching, may be attributed to difficulty in predicting rejection episodes. [4]
| Conclusion | | |
Even though kidney transplantation experience in Erbil is in its early phase and facing many challenges, the reported results are so far encouraging for a promising future.
| References | | |
| 1. | Al-Wakeel J, Mitwali AH, Tarif N, et al. Living unrelated transplant: outcome and issues. Saudi J Kidney Dis Transpl 2000;11(4):553-8.  |
| 2. | Einollahi B. Iranian experience with the nonrelated renal transplantation. Saudi J Kidney Dis Transpl 2004;15(4):421-8. |
| 3. | Al Sayyari AA. The history of renal transplantation in the Arab world: A view from Saudi Arabia. Am J Kidney Dis 2008;51(6):1033-46. |
| 4. | Jabur WL, Mohammed Saaed HM, Abdulla K. Acute renal transplant rejection: a single center experience. Saudi J Kidney Dis Transpl 2008; 19(6):948-51 |
| 5. | The Declaration of Istanbul on Organ Trafficking and Transplant Tourism. International Summit on Transplant Tourism and Organ Trafficking in Turkey. Clin J Am Soc Nephrol 2008;3:1227-31. [PUBMED] |
| 6. | Elusta A, Shawish T, Mishra A, et al. Living related donor kidney transplantation in Libya: A single center experience. Saudi J Kidney Dis Transpl 2008;19(5):831-7. |
| 7. | Moosa MR. The long-term outcome of kidney transplantation in patients under cyclosporine a developing country experience. Clin Transplant 2004;18(3):267-73. |
| 8. | Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med 2009;360(5):459-69. |
| 9. | Nejatisafa AA, Mortaz-Hedjri S, Malakoutian T, et al. Quality of life and life events of living unrelated kidney donors in Iran: A multicenter study. Transplantation 2008;86(7):937-40. |
| 10. | Nemati E, Taheri S, Pourfarziani V, et al. Cytomegalovirus disease in renal transplant recipients: an Iranian experience. Exp Clin Transplant 2008;6(2):132-6. |
Correspondence Address:
Pishtewan H Al-Bazzaz
Assistant Professor of Urology, Consultant Kidney Transplant Surgeon, Hawler Medical University, Erbil
Iraq
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PMID: 20228533 
[Table 1], [Table 2], [Table 3], [Table 4] |
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| Piskin, T. and Unal, B. and Koz, S. and Ulutas, O. and Yagmur, J. and Beytur, A. and Kayhan, B. and Taskapan, H. and Sahin, I. and Baysal, T. | | Transplantation Proceedings. 2012; 44(6): 1685-1689 | | [Pubmed] | |
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