Living unrelated (paid) kidney transplantation in Third-World countries: High risk of complications besides the ethical problem
Identifieur interne : 002C30 ( Main/Exploration ); précédent : 002C29; suivant : 002C31Living unrelated (paid) kidney transplantation in Third-World countries: High risk of complications besides the ethical problem
Auteurs : M. Sever [Turquie] ; T. Ecder [Turquie] ; A. E. Aydin [Turquie] ; A. Türkmen [Turquie] ; I. Killçaslan [Turquie] ; V. Uysal [Turquie] ; H. Eraksoy [Turquie] ; S. Çalangu [Turquie] ; M. Çarin [Turquie] ; U. Eldegez [Turquie]Source :
- Nephrology Dialysis Transplantation [ 0931-0509 ] ; 1994.
Abstract
Due to inadequate cadaveric and living related organ supply, many end-stage renal disease patients go to third-world countries for living unrelated (paid) kidney transplantation. Thirty-four patients who have had transplantations in two centres in India before coming to our centre for post-transplant care and follow-up are reported in this study. In the post-transplant phase at our centre, the mean follow-up period of the patients was 209.7±137.3 (range 6—450) days. Fourteen of them, having an uneventful course, were followed on an outpatient clinic basis. The rest of the patients were hospitalized because of the following surgical and/or medical complications during admission: urinary fistula in two patients; lymphocele in three patients; urinary tract obstruction in two patients; decubitus ulcer in one patient; severe wound infection in one patient; subacute myocardial infarction in one patient; acute irreversible vascular rejection in two patients; urinary tract infection in two patients; pneumonia in two patients; congestive heart failure and severe electrolyte disturbance in two patients; post-transplant diabetes mellitus and ketoacidosis in one patient; cyclosporin nephrotoxicity in two patients; cyclosporin nephro-, hepato-, and neurotoxicity in one patient. Plasmodium falciparum malaria in three patients, generalized mucormycosis infection in one patient, and genitourinary aspergillosis in one patient were seen during the first month. Hepatitis B virus infection followed by chronic active hepatitis was diagnosed in two patients, 2 and 4 months after the operation; and Kaposi's sarcoma was noted in another two patients, 1 and 5 months after the operation. One of the patients died as a result of disseminated mucormycosis and another one as a result of pneumonia. Transplant nephrectomy was performed in the case of two other patients because of irreversible symptomatic rejection. A possible cause of the above-cited high incidence of complications was thought to be the inadequate evaluation of the donors and the patients in the preoperative period. Furthermore, many of the patients were sent to their countries without treatment of postoperative-period complications. It was concluded that living unrelated (paid) kidney transplantation in developing countries carried high risks of medical and/or surgical complications, beside the ethical problems.
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DOI: 10.1093/oxfordjournals.ndt.a092867
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Sever</name><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul School of Medicine, Transplantation Unit, capa/Topkapi/lstanbul</wicri:regionArea><wicri:noRegion>capa/Topkapi/lstanbul</wicri:noRegion></affiliation><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Correspondence and offprint requests to: Doc. Dr Mehmet Sükrü Sever, Ataköy, 4. Kisim, TO Blok, No:216, D:15, 34750, Bakirköy, Istanbul</wicri:regionArea><wicri:noRegion>Istanbul</wicri:noRegion></affiliation></author><author><name sortKey="Ecder, T" sort="Ecder, T" uniqKey="Ecder T" first="T." last="Ecder">T. Ecder</name><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul School of Medicine, Transplantation Unit, capa/Topkapi/lstanbul</wicri:regionArea><wicri:noRegion>capa/Topkapi/lstanbul</wicri:noRegion></affiliation></author><author><name sortKey="Aydin, A E" sort="Aydin, A E" uniqKey="Aydin A" first="A. E." last="Aydin">A. E. Aydin</name><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul School of Medicine, Transplantation Unit, capa/Topkapi/lstanbul</wicri:regionArea><wicri:noRegion>capa/Topkapi/lstanbul</wicri:noRegion></affiliation></author><author><name sortKey="Turkmen, A" sort="Turkmen, A" uniqKey="Turkmen A" first="A." last="Türkmen">A. Türkmen</name><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul School of Medicine, Transplantation Unit, capa/Topkapi/lstanbul</wicri:regionArea><wicri:noRegion>capa/Topkapi/lstanbul</wicri:noRegion></affiliation></author><author><name sortKey="Killcaslan, I" sort="Killcaslan, I" uniqKey="Killcaslan I" first="I." last="Killçaslan">I. Killçaslan</name><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul School of Medicine, Transplantation Unit, capa/Topkapi/lstanbul</wicri:regionArea><wicri:noRegion>capa/Topkapi/lstanbul</wicri:noRegion></affiliation></author><author><name sortKey="Uysal, V" sort="Uysal, V" uniqKey="Uysal V" first="V." last="Uysal">V. 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Çalangu</name><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul School of Medicine, Transplantation Unit, capa/Topkapi/lstanbul</wicri:regionArea><wicri:noRegion>capa/Topkapi/lstanbul</wicri:noRegion></affiliation></author><author><name sortKey="Carin, M" sort="Carin, M" uniqKey="Carin M" first="M." last="Çarin">M. Çarin</name><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul School of Medicine, Transplantation Unit, capa/Topkapi/lstanbul</wicri:regionArea><wicri:noRegion>capa/Topkapi/lstanbul</wicri:noRegion></affiliation></author><author><name sortKey="Eldegez, U" sort="Eldegez, U" uniqKey="Eldegez U" first="U." last="Eldegez">U. Eldegez</name><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Istanbul School of Medicine, Transplantation Unit, capa/Topkapi/lstanbul</wicri:regionArea><wicri:noRegion>capa/Topkapi/lstanbul</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Nephrology Dialysis Transplantation</title><idno type="eISSN">1460-2385</idno><idno type="ISSN">0931-0509</idno><imprint><publisher>Oxford University Press</publisher><date when="1994">1994</date><biblScope unit="vol">9</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="350">350</biblScope><biblScope unit="page" to="354">354</biblScope></imprint><idno type="ISSN">0931-0509</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0931-0509</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Due to inadequate cadaveric and living related organ supply, many end-stage renal disease patients go to third-world countries for living unrelated (paid) kidney transplantation. Thirty-four patients who have had transplantations in two centres in India before coming to our centre for post-transplant care and follow-up are reported in this study. In the post-transplant phase at our centre, the mean follow-up period of the patients was 209.7±137.3 (range 6—450) days. Fourteen of them, having an uneventful course, were followed on an outpatient clinic basis. The rest of the patients were hospitalized because of the following surgical and/or medical complications during admission: urinary fistula in two patients; lymphocele in three patients; urinary tract obstruction in two patients; decubitus ulcer in one patient; severe wound infection in one patient; subacute myocardial infarction in one patient; acute irreversible vascular rejection in two patients; urinary tract infection in two patients; pneumonia in two patients; congestive heart failure and severe electrolyte disturbance in two patients; post-transplant diabetes mellitus and ketoacidosis in one patient; cyclosporin nephrotoxicity in two patients; cyclosporin nephro-, hepato-, and neurotoxicity in one patient. Plasmodium falciparum malaria in three patients, generalized mucormycosis infection in one patient, and genitourinary aspergillosis in one patient were seen during the first month. Hepatitis B virus infection followed by chronic active hepatitis was diagnosed in two patients, 2 and 4 months after the operation; and Kaposi's sarcoma was noted in another two patients, 1 and 5 months after the operation. One of the patients died as a result of disseminated mucormycosis and another one as a result of pneumonia. Transplant nephrectomy was performed in the case of two other patients because of irreversible symptomatic rejection. A possible cause of the above-cited high incidence of complications was thought to be the inadequate evaluation of the donors and the patients in the preoperative period. Furthermore, many of the patients were sent to their countries without treatment of postoperative-period complications. It was concluded that living unrelated (paid) kidney transplantation in developing countries carried high risks of medical and/or surgical complications, beside the ethical problems.</div></front></TEI><affiliations><list><country><li>Turquie</li></country></list><tree><country name="Turquie"><noRegion><name sortKey="Sever, M" sort="Sever, M" uniqKey="Sever M" first="M." last="Sever">M. Sever</name></noRegion><name sortKey="Aydin, A E" sort="Aydin, A E" uniqKey="Aydin A" first="A. E." last="Aydin">A. E. Aydin</name><name sortKey="Calangu, S" sort="Calangu, S" uniqKey="Calangu S" first="S." last="Çalangu">S. Çalangu</name><name sortKey="Carin, M" sort="Carin, M" uniqKey="Carin M" first="M." last="Çarin">M. Çarin</name><name sortKey="Ecder, T" sort="Ecder, T" uniqKey="Ecder T" first="T." last="Ecder">T. Ecder</name><name sortKey="Eldegez, U" sort="Eldegez, U" uniqKey="Eldegez U" first="U." last="Eldegez">U. Eldegez</name><name sortKey="Eraksoy, H" sort="Eraksoy, H" uniqKey="Eraksoy H" first="H." last="Eraksoy">H. Eraksoy</name><name sortKey="Killcaslan, I" sort="Killcaslan, I" uniqKey="Killcaslan I" first="I." last="Killçaslan">I. Killçaslan</name><name sortKey="Sever, M" sort="Sever, M" uniqKey="Sever M" first="M." last="Sever">M. Sever</name><name sortKey="Turkmen, A" sort="Turkmen, A" uniqKey="Turkmen A" first="A." last="Türkmen">A. Türkmen</name><name sortKey="Uysal, V" sort="Uysal, V" uniqKey="Uysal V" first="V." last="Uysal">V. Uysal</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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