Outcome of living unrelated (commercial) renal transplantation

Outcome of living unrelated (commercial) renal transplantation. Due to inadequate cadaveric and living related organ supply, many end-stage renal disease patients go to Third World countries for commercial transplantation, although the high risk of complications is well established and ethical argum...

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Bibliographic Details
Published in:	Kidney international Vol. 60; no. 4; pp. 1477 - 1483
Main Authors:	Sever, Mehmet Şükrü, Kazancioğlu, Rümeyza, Yildiz, Alaattin, Türkmen, Aydin, Ecder, Tevfik, Kayacan, S. Mehmet, Çelik, Vedat, Şahin, Sevgi, Aydin, A. Emin, Eldegez, Uluğ, Ark, Ergin
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-10-2001 Nature Publishing Elsevier Limited
Subjects:	Adult Aged Bioethics Biological and medical sciences cadaveric organ donation Combined surgery. Multiple transplantations Developing Countries end-stage renal disease Female Graft Rejection Graft Survival Humans India Infection - etiology Iran Iraq Kidney Transplantation - adverse effects Kidney Transplantation - mortality Living Donors living unrelated transplantation Male Medical sciences Middle Aged organ transplant Postoperative Complications Retrospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Analysis transplant ethics Treatment Outcome Turkey Turkey Iraq Iran India transplant ethics cadaveric organ donation organ transplant end-stage renal disease living unrelated transplantation Human Living donor Transplantation Homotransplantation Survival Kidney Marketing Ethics Surgery Risk factor Complication Third World Cadaver Organ Empirical Approach Health Care and Public Health
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Summary:	Outcome of living unrelated (commercial) renal transplantation. Due to inadequate cadaveric and living related organ supply, many end-stage renal disease patients go to Third World countries for commercial transplantation, although the high risk of complications is well established and ethical arguments debate this practice. The midterm outcome of 115 patients who had been commercially transplanted in various countries and admitted to our center for post-transplant care and follow-up between 1992 and 1999 was retrospectively analyzed. Data considering the transplantation practice and post-transplant course were collected from the patient files. Outcome of these patients was compared with those with a living related transplant performed at our center. The patients (91 male and 24 female; mean age of 42 ± 12 years) were transplanted in India (N = 106), Iraq (N = 7), and Iran (N = 2). The mean follow-up period was 64.5 ± 23.9 months. Post-transplant course was complicated by numerous surgical and/or medical complications, and many of the latter were unconventional infections caused by malaria, invasive fungal infections, and pneumonia due to various opportunistic pathogens. Overall, 52 patients still have functioning allografts, while 22 lost their grafts, 20 died, and 21 were lost to follow-up. Graft survival rates at two, five, and seven years were 84, 66, and 53%, respectively, for the study group, while it was 86, 78, and 73% for living related transplantations performed at our center (P = 0.036). Patient survival rates for the same periods were 90, 80, and 74% for the study group and 90, 85, and 80% for the living related transplantations (P = 0.53). Besides the ongoing ethical debate, commercial transplantation carries a high risk of unconventional complications, and despite that the patient survival rate is comparable, graft survival is worse than conventional living related transplantations at the midterm.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0085-2538 1523-1755
DOI:	10.1046/j.1523-1755.2001.00951.x