Pediatric living-related liver transplantation in Saudi Arabia.

OBJECTIVE: The purpose of this paper is to report our experience of the first 29 consecutive living-related liver transplants in pediatric recipients and to demonstrate the feasibility of living-related liver transplantation in the Arab World. The first living-related liver transplantation in the Kingdom of Saudi Arabia was performed in November 1998 by Bassas et al following an appropriate period of multi-disciplinary preparation. METHODS: This study was carried out at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia, during the period November 1998 through to October 2001. A review of the data of the transplanted children and adult donors was carried out. The data recorded for recipients included age, sex, patient's weight, preoperative diagnosis, intraoperative surgical complications, graft size and weight, medical and surgical postoperative complications, immunosuppression, rejection and overall survival rate. Data recorded for the donors included age, sex and any postoperative complications. RESULTS: The most frequent indication for living-related liver transplantation in our series was metabolic liver disease. Post-operative complications included biliary leaks in 10% (N=3), vascular occlusion in 13% (N=4), acute cellular rejection in 38% (N=11), positive cytomegalovirus PP65 antigen in 38% (N=11), wound infection in 3.4% (N=one), and systemic infections in 14% (N=4). One urgent retransplantation was necessary due to thrombosis of the hepatic artery. Patient and graft survival rates are 96% and 93%. One patient, treated for acute liver failure, died 2 months post-transplant. CONCLUSION: Our experience has shown pediatric living-related liver transplantation to be a success whilst alleviating the need for sending Saudi patients overseas for treatment and providing a solution to organ shortages for pediatric patients. In general, this endeavor has broadened the spectrum of our experience in surgery, anesthetics, intensive care and pediatrics.

Innovations in pancreas transplantation.

Pancreas transplantation is currently the curative treatment for type 1 diabetes mellitus. It aims at providing physiological insulin replacement therapy in type 1 diabetes mellitus. The goal is thereby also to prevent secondary complications of diabetes. Long term control of glucose metabolism has only been achieved by pancreas transplantation. As a result of improvements in the surgical techniques and the efficacy of immunosuppression, the patient and graft survival rates have improved dramatically over the last 2 decades. As a result, pancreas transplantation, as part of simultaneous pancreas and kidney transplantation, pancreas after kidney transplantation, and exceptionally pancreas transplantation alone, became the standard therapeutic option for patients with type 1 diabetes mellitus with end-stage renal disease. In this article we review the pancreas transplantation methods, indications, techniques, and the short as well as the long outcomes of treatment.