RESUMEN
OBJECTIVE: Indonesia has overcome several barriers to the growth of kidney transplantation within the past decade. Currently, the procedure is increasingly performed in several centers across the country. However there are limited publications on kidney transplantation from Indonesia, especially from centers outside Jakarta. This study aims to give a brief overview on transplantation performed, discuss current efforts and progresses of transplantation in Indonesia and chiefly Semarang. METHODS: Retrospective analysis of 20 transplant cases in Semarang during 2014-2018 was performed. Information from other transplant centers was acquired through formal correspondences with 11 central teaching hospitals in Jakarta, Surabaya, Yogyakarta, Malang, Bali, Solo, Palembang, Aceh, Medan, Bandung, and Padang. RESULTS: There were 629 recorded kidney transplantations performed in 12 centers, and we report on 245 cases with viable data. The average age of kidney recipients were younger (35.4 years old) compared to the donors (41.3 years old). Approximately half of the kidneys were obtained from related donors (49.0%) and there was only one case of cadaveric donor. The three leading etiologies of end-stage renal disease were hypertension (37.4%), diabetes mellitus (26.1%), and autoimmune disease (11.3%). There is only one center that has performed more than 100 kidney transplants in Indonesia. CONCLUSION: Indonesia has successfully overcome several major hurdles that had previously hindered the growth of transplantation. Further improvement should concentrate on the development of integrated organ transplant infrastructure, decentralization of transplant professionals, establishment of National kidney transplant database and changing the Nation's paradigm on cadaveric organ donor through public education.
RESUMEN
We report middle age man with skin hyperpigmentation oral and lip mucous membranes, general malaise and depression. Further examinations lead to adrenal insufficiency, Addison's disease. Imaging studies show bilateral adrenal hyperplasia, show negative result for tuberculosis. We perform laparoscopic adrenalectomy. Multiple caseosa necrosis in gross specimen and Langhan's giant cells microscopic appearance ensure patient suffered Addison's disease cause by adrenal gland tuberculosis.