The Challenge of Graft Nephrectomy after Transplant Tourism.

The morbidity and mortality rates of transplant nephrectomy are closely related to the indications of nephrectomy. This study evaluates the indications, etiology, and complications of graft nephrectomies for commercial kidney transplantation (CKT). Data were analyzed retrospectively for graft nephrectomies for CKT from January 2009 to December 2017 at the Royal Hospital, Muscat, Oman. Four hundred and three patients received CKT and 34 patients required a nephrectomy. Twenty-five patients had a nephrectomy within 10 weeks of CKT in the early group, and nine patients in the late group had the graft removed later than 10 weeks. Indications for nephrectomy in the early group were acute bleeding, infarcted kidney, and pyonephrosis in 7, 11, and 7 patients, respectively; in the late group, the indications were: pain, hematuria, fever, hypertension, and infection. Overall, seven patients had major blood loss, and those patients who had a pseudoaneurysm had tissue cultures that were positive for the fungus. Postoperative complications occurred in 26 patients. There was acute bleeding in three patients from the external iliac artery at the site of the previous anastomosis, and, in all three cases, the external iliac artery was ligated. There were 12 major wound infections, and three patients died from overwhelming sepsis and disseminated intravascular coagulation. Commercial transplants carry a high risk of immunological, vascular, and infectious complications, resulting in significant morbidity and mortality.

Pediatric Renal Transplantation in Oman: A Single-center Experience.

OBJECTIVES: This study sought to report 22 years experience in pediatric kidney transplantation in Oman. METHODS: Electronic charts of all Omani children below 13 years of age who received a kidney transplant from January 1994 to December 2015 were reviewed. Data collected included patient demographics, etiology of end-stage kidney disease, modality and duration of dialysis, donor type, complication of kidney transplantation (including surgical complications, infections, graft rejection) graft and patient survival, and duration of follow-up. RESULTS: During the study period transplantation from 27 living related donors (LRDs), 42 living unrelated donors (LURDs), also referred to as commercial transplant, and one deceased donor were performed. The median age at transplantation was nine years for both groups. The most common primary diagnosis was congenital anomalies of the kidney and urinary tract in 32.8% of patients followed by familial nephrotic syndrome in 20.0% and polycystic kidney disease in 18.5%. Almost half the patients were on hemodialysis before transplantation, 35.7% were on peritoneal dialysis, and 14.2% received preemptive renal transplantation. Children who received LURD kidneys had high surgical complications (42.8%) compared to the LRDs group (17.8%). Five patients from LURDs group had early graft nephrectomy and four patients developed non-graft function or delayed graft function. In addition, patients in the LURDs group had a higher incidence of hypertension and acute rejection. Graft and patient survival were both better in the LRDs than the LURDs group. CONCLUSIONS: Although our pediatric kidney transplant program is a young program it has had successful patient outcomes comparable to international programs. Our study provides evidence that in addition to legal and ethical issues with commercial transplant, it also carries significantly higher morbidity and reduced graft and patient survival.