RESUMO
Background: The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommends statin treatment for all adult kidney transplant recipients (KTRs), except those aged <30 years of age and without prior cardiovascular risk factors (CVRF), but does not specify on-treatment low-density lipoprotein cholesterol (LDL) target levels. The 2018 American Heart Association (AHA) guidelines addressed the management of hyperlipidemia in the general population based on an individualized approach of the CVRF with a specific on-treatment LDL target. Objective: To analyze dyslipidemia management according to the recommendations of the KDIGO and AHA guidelines. Methods: This retrospective study included all KTRs who underwent transplantation between January 2017 and May 2020 at King Abdulaziz Medical Center, Riyadh, Saudi Arabia. The rate of statins prescription in general, rate of statins prescription among KTRs per their CVRF, and rate of achieving the proposed LDL goals, as defined by the AHA, were analyzed. Results: A total of 287 KTRs were included. Of the 214 (74.6%) patients aged ≥30 years, 80% received a statin. Statins were prescribed in 93% and 96% of KTRs with diabetes or coronary artery disease, respectively. In patients aged ≥30 years, LDL targets, per AHA guidelines, were achieved in 62% with a target of 2.6 mmol/l, and in 19% with a target of 1.8 mmol/l. Statin therapy resulted in non-significant changes in the mean LDL values from baseline to 12 months after transplantation (P = 0.607), even when only patients prescribed statin after transplantation were included (P = 0.34). Conclusion: By applying the KDIGO guidelines, a high rate of statin prescriptions was achieved among KTRs with multiple CVRF and KTRs in general. However, a significant proportion of these KTRs did not achieve the LDL targets proposed by the AHA guidelines, suggesting that higher-intensity statins would be required to achieve these targets.
RESUMO
Background The supply-demand mismatch between organ donor and patient waiting for transplant has led to the growth of transplant tourism. This type of transplant is considered unethical and illegal, as it is usually performed in poor environments and carries a higher risk of infectious, vascular, and immunological complications. Methods In this single-centered retrospective cohort study, we compared patients who underwent transplant tourism to patients who were transplanted locally and followed up in our hospital from January 2015 to December 2018. Result A total of 254 local transplants and 60 patients from the transplant tourism group were included. Transplant tourism recipients were younger otherwise both groups were similar in gender, body mass index, diabetes, and hypertension. Recipients in the transplant tourism group had a significantly higher rate of delayed graft function (18.3% vs. 6.3%, p 0.005), acute rejection (40% vs. 7.9%, p < 0.001), and higher posttransplant infection in general. With more urological complications and higher graft failure at 3-years' follow-up (11.7% vs. 0.8%, p < 0.001). Conclusion Transplant tourism is associated with a higher risk of infection and poor graft outcomes. Extra efforts are required to cut down transplant tourism by educating patients about its clinical risk and ethical considerations. In addition, measures to increase the number of deceased donor pool to provide a better alternative options for patients are essential.
