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. 2016 Apr;8(Suppl 2):S189–S197.

Renal Transplant

PMCID: PMC4869449
Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

The role of scot in organ transplantation in the KSA

F. A. M. Shaheen, A. R. Al Swailem

Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia

Saudi Center for Organ Transplantation (SCOT) erstwhile National Kidney Foundation (NKF), was established in 1985 as the central co-ordinating body for renal care facilities and renal transplantation in the Kingdom of Saudi Arabia (KSA). During the pre-NKF period, renal care facilities existing were inadequate to combat the problem of renal failure patients in Saudi Arabia, where the reported incidence of ESRD was between 70-113 PMP. The number of transplantation abroad which was then associated with high degree of morbidity. For establishing a database in the Kingdom, a large main frame computer was installed, connected to all peripheral dialysis centres with facility for direct data input. The computer also maintains a waiting list for patients requiring transplantation as well as data of medical and consumable supplies to various centres. NKF succeeded in launching a successful cadaveric organ transplantation program, by increasing the awareness of the public and medical personnel about the concept of brain death and importance of organ transplantation programs for various organs such as heart, lung, liver and pancreas, in addition to the already existing corneal and renal transplantation programs. SCOT divided the Kingdom to various zones. In each zone, several hospitals were connected to a transplant center. This has resulted in a remarkable increase in brain death reporting, organ retrieval, and number of transplantations being performed. Till December 12, 1994, 589 kidneys from cadavers, 56 whole hearts, 166 heart valves, 4 pancreases, 44 livers, and 121 corneas were transplanted in the Kingdom of Saudi Arabia. With the enviable success it has achieved, SCOT has become a role model for any country intending establish a comprehensive end stage organ failure treatment program.

Presented at the: 9th Saudi Urology Conference King Fahad Hospital – Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Review of 1st 50 renal transplantation's at King Fahad Armed Forces Hospital – Jeddah

S. Balawy, A. Garoushe

Department of Urology and Surgery, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia

We would like to present our limited experience to our colleague of 1st 50 Renal Transplant at King Fahd Armed Forces Hospital - Jeddah starting 1991-1995.

Summary of Result:

Transplant:

L.R. + L.U. = 80%

CAD = 20%

Children = 10%

Adult = 90%

Patient Survival:

  • Live Related Donor = 100%

  • Recipient = 98%

Graft Survival:

  • L.R. = 95%

  • CAD = 90%

Presented at the: 9th Saudi Urology Conference King Fahad Hospital – Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Renal transplantation in Saudi Arabia

F. A. M. Shaheen, M. Z. Souriyyeh, A. R. Al Swailem

Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia

The first renal transplant was in 1979. Initially, renal transplantation was performed using live related donors and cadaveric kidneys that were harvested abroad. There were no local cadaveric donors. The Jurisprudence of Islamic Ulema (scholars) approving the acts of organ donation and transplantation in 1982 heralded the true era of transplantation's programs in the Kingdom. The National Kidney Foundation (NKF) was established in 1985 by the Government of the Kingdom of Saudi Arabia. The NFK was upgraded in 1993 and renamed as Saudi Center for Organ Transplantation (SCOT), to encompass transplantation of organs other than the kidney as well. The results of organ transplantation in Saudi Arabia are followed up regularly by SCOT in co-ordinations with the transplant centres. Till the end of 1994 there were 1621 renal transplants performed in Saudi Arabia (8.3 renal transplants PMP per year). Of them 956 transplants were from living related donors, 600 renal transplants from local cadaveric donors, besides 65 renal transplants from cadaveric donors harvested abroad performed before establishing NKF. There has been an increasing trend in the number of the renal transplants over years, to reach 276 renal transplants in 1994. Currently, there are 13 centres for renal transplantation in Saudi Arabia. The average patient and graft survival rates of the cadaveric renal transplants were 95% and 82% respectively after three years of transplantation, while the average patient and graft survival rates for the living related transplants were 95% and 92% respectively after the same period of follow up. We conclude that renal transplantation is a well established modality of therapy for end stage renal failure in Kingdom of Saudi Arabia. However, mortgage of donors is still limiting factor.

Presented at the: 9th Saudi Urology Conference King Fahad Hospital – Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Endo-urologic management of ureteric complications after live-donor kidney transplantation

Ahmed A. Shokeir, Tarek A. El Diasty, Mohamed A. Ghoneim

Mansoura Urology and Nephrology Center, Mansoura, Eygept

Among 620 consecutive live-donor kidney transplants, 40 patients (6.5%) developed ureteric complications in the form of fistula (n = 16) or obstruction (n = 24). Patients with these complications were stratified into two consecutive groups according to the use of graft per-cutaneous nephrostomy (PCN) in their initial management. Group A was comprised of 17 patients (8 fistulas and 15 obstructions) were initially treated by graft PCN until resolution of azotemia and control of infection, then treated definitively by endo-urologic procedures or open surgery. Patients of Group B demonstrated significantly better graft function 2 weeks after treatment, better 1 year graft survival, a shorter hospital stay, and a lower incidence of secondary post-treatment complications. Moreover, in this group of patients, endo-urologic procedures provided definitive management in 3 of 8 patients with ureteric fistula and in 9 of 15 patients with ureteric obstruction. These data supplement the growing evidence that endo-urologic techniques are good adjuncts to or substitutes for open surgery in renal allograft recipients with ureteric complications.

Presented at the: 9th Saudi Urology Conference King Fahad Hospital – Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Urological complications in cadaveric renal transplant

M. T. Said, M. S. Abomelha, S. Orkubi, K. E. Al Otaibi, A. Shaaban

Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Between 1983 and 1995, a total of 200 cadaveric renal transplantation's were performed in 180 patients of whom 29 were re-grafted. There were 95 females and 85 males. Children under 16 years old were 29. The grafts included 136 (68%) locally harvested and 64 (32%) imported from Eurotransplant Foundation. Leadbetter-Politano ureteric neocystostomy without ureteric stenting was used in all patients and bladders were drained by a urethral catheter for 3-4 days.

A total of 14 urological complications occurred in 13 patients (6.5%). These complications were: urine leak in 4 cases (2%), obstruction in 7 (3.5%), urethral stricture in 2 (1%) and stone formation in one. Successfully treated urological complications amounted to 85%. Associated infection with urine leak resulted in loss of two grafts.

We conclude that urological complications can threaten graft survival. Prompt recognition and treatment utilizing percutaneous techniques would allow a high rate of graft salvage.

Presented at the: 9th Saudi Urology Conference King Fahad Hospital – Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Cadaveric renal transplant: Experience with 200 grafts

M. S. Abomelha, S. Orkubi, M. Said, K. Al Otaibi, M. Kourah, A. Shaaban

Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Between 1979 and 1995, 200 cadaveric renal transplants were performed in 180 patients. The age of patients ranged 4-61 with a mean of 29 years. There were 95 females and 85 males. Among these patients, 29 were children under the age of 16 years. The source of grafts were 136 local and 64 imported. Fifty-one grafts were from paediatric donors. The mean Cold Ischemic Time was 29 hours and all recipients were immuno-suppressed with Cyclosporine and Prednisolone.

Postoperative surgical complications were vascular in 16.5%, urological in 6.5%. Late surgical complication were rare. The one year and 5 years graft survival were 80% and 69% respectively, while the patient survival were 93% and 87% respectively.

We conclude that our experience of cadaveric renal transplants are comparable to those reported in the literature.

Presented at the: 9th Saudi Urology Conference King Fahad Hospital – Jeddah 14-16 November 1995

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

High risk transplant patients

David E. R. Sutherland

Division of Transplant Surgery, Diabetes Institute of Immunology and Transplantation, University of Minnesota, Minneapolis, MN, USA

The term “high risk” is a common jargon in the transplant literature, but the question must be asked do we mean high risk for the patient or high risk for the transplant center's result relative to other patient groups. Most centers use the term “high risk” to mean high risk for the transplant results. From a patient's perspective, the question is: Are my chances of survival higher with the transplant or with the alternative treatment (dialysis)? If survival probability is higher on dialysis the transplant is truly improving quality of life. However, for most patients labeled as “high risk”, the transplant is still low risk option. For example, the five year survival of diabetics on dialysis is only 20% while with a transplant it is 80%. Another example, for patients with coronary artery diseases, the risk of a myocardial infarct during one year of dialysis (100 runs) is as high or higher than a MI with 1 time surgery (the transplant). If we accept in traditional definition, high risk for our results, how can we improve the results and turn what would have been a high risk group into a standard risk group. For patients with coronary artery disease does a bypass or angioplasty pre-transplant is possible, even if asymptomatic. This is a category where survival is improved by the intervention independent of an effect on symptoms. Other examples will be given showing that for most patients labeled as “high risk”, transplantation is still “low risk” option relative to other treatments.

Presented at the: 11th Saudi Urology Conference King Fahd Military Medical Complex – Dhahran 24-26 February 1998 (27-29 Shawwal 1418)

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Ureteral reimplantation in 1218 kidney transplantations

N. Simforoosh, A. Basiri, M. H. Nourbala

Department of Urology, Shahid Labbafi Nejad Medical Center, Shahid Beheshti University of Medical Sciences, Baghiatollah Medical Center, Tehran, I.R. Iran

1218 kidney transplantations were performed from 1984 until 1997. In 201 recipients ureteral reimplantation were performed using Leadbetter technique. In 1017 recipients modified Lich Gregoir technique was used for ueteral reimplantation. Ureteral fistula rate was 8% in Leadbetter group, while it was only 2.1% in Lich group. Within Lich group if stent was not used fistula rate was 4.5% while in Lich group with double J stenting, only 0.7% ureteral fistula was seen.

Conclusion: Modified Lich Gregoir technique is a preferred technique with less ureteral leak and less operative time.

Presented at the: 11th Saudi Urology Conference King Fahd Military Medical Complex – Dhahran 24-26 February 1998 (27-29 Shawwal 1418)

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Effect of Ramadan fasting on Moslem kidney transplant recipients

A. H. Abdalla, Z. Rassoul, A. K. Owda, W. Popovich, D. H. Mousa, F. Al Hawas, M. H. Al Sulaiman, A. A. Al Khader

Department of Nephrology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

This study was carried out to find whether fasting during Ramadan would affect renal function in kidney transplant recipients with normal or impaired graft function. Twenty tree transplant recipients, 17 with normal function, 6 have impaired but stable function with plasma creatinine level not exceeding 300 mmol/L were included in this study. The mean post transplant period was 2.0 years (range 0.6–6.3 years). Urine and serum biochemical parameters, cyclosporine (CsA) level, haematocrite, were checked weekly during Ramadan as well as one week before and after Ramadan. Statistical analysis showed no significant changes in all the parameters before, during, and after Ramadan.

Conclusion: Our findings indicate that fasting in the month of Ramadan does not seem to be associated with any significant adverse effects in kidney transplant recipients with normal or impaired graft function and suggests that it is safe for those patients to fast during Ramadan after 1 year of renal transplantation.

Presented at the: 11th Saudi Urological Conference King Fahd Military Medical Complex – Dhahran 24-26 February 1998 (27-29 Shawwal 1418)

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Related urologic complications in renal transplant recipient at RMC

M. S. Tarsin, A. Mitwalli, T. Al Shaier

Department of Urology, Riyadh Medical Complex, Riyadh, Saudi Arabia

In the Kingdom of Saudi Arabia renal transplantation has become the ultimate form of treatment for end stage renal disease. The incidental of ESRD has been repeated to be as high as 70 patients per million per year in 92, and today may exceed that number because of improvement in the early diagnosis in these cases. This report is aimed to present urologic complication in renal transplant recipient, referred to our center describing their etiologic bases, diagnosis and treatment.

Patients and Methods: Revised 383 patients have transplanted between June 1982 – November 1991; of these 270 (70.7%) have been transplanted from living non related (LNRD), 59 (15.3%) from living related donors (LRD) and 54 (13.9%) from cadaveric donor. Male patients 287 (74.8%) and female were 96 (25.2%), M:F ratio was 3:1. Age range was 14-65 years. The maintenance immunosuppresion medication consisted of triple drug therapy: cyclosporine, prednisone and immuran in 369 (96%), prednisone and immuran only in 14 patients (3.7%). Total number of patients stented were 151 (39.3%) and not stented 232 (60.7%).

Complications: Ureteric obstruction with hydronephrosis was seen in 5 cases. Two further cases were due to extrinsic compression by large lymphocele. Management was with insertion of DJ in (3), open stenting in (1), defect oversewn (1). Urinary leak were 17 cases (4.4%) at ureteral vesical junction, early due to technical factors (13) or a late due to sloughed ureter secondary to ischemia (4). Management was with insertion of DJ in the early group. The late (4) Boari flap (2) and two were lost. Lymphocele 73 cases (21.1%), 85% occurred subsequent to the first allograft, and the remainder after the second graft. Tenderness and swelling over the transplant site were the most common findings. Recurrent infection was encountered in 39 cases (10.1%) mostly associated with neglected DJ stent post transplant. Two cases with a proline sutureate the vesico-ureteric anastomosis. Management with removal of neglected DJ, antibiotics and removal of the proline suture.

Discussion: Despite improved results in renal transplantation during the last decades, technical complications continue to be the major factors contributing to morbidity and mortality.

Conclusion: Most renal transplant urological complications remain a grave cause of concern owing to the attendant patient mortality and graft loss. Most underlying causes were technical in nature and can be prevented if not avoided. The high incidence of these complications in our patient is due to the fact that most of these transplants were done under illegal circumstances and lacks all surgical precision.

Presented at the: 14th Saudi Urological Conference 13-15 February 2001 (19-21 Dhu Al Qa’dah 1421) King Fahd Military Medical Complex – Dhahran

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Renal transplantation and female gender: A single institution experience

A. B. Shehab El-Dein, A. A. Shokeir, M. M. El-Mekresh, B. Ali-El-Dein, Y. M. Osman, M. A. Sobh, M. A. Bakr, N. Hassan, I. Wahba, A. S. Fouda, M. S. Ghanem, M. A. Ghoneim

Urology and Nephrology Center, Mansoura, Egypt

Introduction and Objectives: Some recent literature indicated that, compared to male gender, graft survival from female donors is inferior while graft survival in a female recipient is superior. The aim of the present work is to study the effect of gender upon the long term graft survival in live-donor kidney transplants. The impact of pregnancy was also indicated.

Materials and Methods: Between March 1976 and December 1998, 1200 consecutive living donor renal allotransplants were carried out in Mansoura Urology and Nephrology Center. The follow up period ranged from 2 to 21.1 years (mean 5.5 + 4.1 for grafts and 5.7 + 4.1 for recipients). The impact of graft survival from and to female gender compared to the male one was assessed using Kaplan-Meier curves and log rank test.

Results: Although there was an equal donation rates between genders, males constituted more than two thirds of our recipient population cohort. The 5-year graft survival of male recipients was 75.2% compared with 76.8% in female recipients (P = 0.61) irrespective of the gender of their donors. On the other hand the 5-year survival of grafts obtained from males was 77.3% compared with 73.9% for those obtained from females (P = 0.15) irrespective of the gender of their recipients. In our experience, 49 pregnancies were encountered in 29 female recipients. Twelve patients were maintained on triple therapy, 9 patients received conventional immunosuppression while 8 patients were kept on Cyclosporine A (CsA) and steroids. The pregnancies resulted in 35 live-birth (71.4%), 3 still-birth (6.1%), 11 abortions (22.5%). Among the live-births, prematurity was observed in 21 neonates (60%) and low birth weight in 10 (29%) while minor anomaly was observed in 2 (6%). There was no graft loss directly attributed to pregnancy. The mean post-delivery S. creatinine was 1.3 + 0.8 compared with 1.1 + 0.4 in the pre-pregnancy state (p = 0.2).

Conclusions: Generally, there is no significant impact of the gender upon the long term graft survival among live-donor kidney transplants. Under controlled pre-conception criteria, pregnancy can be safely allowed.

Presented at the: 15th Saudi Urological Conference King Fahd Hospital – Madinah Al Munawarah 7-9 May 2002 (24-26 Safar 1423)

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Living donor nephrectomy

S. A. Eqail, A. A. Al Dayel, M. Y. Ezzibdeh, I. Al Oraifi, E. El Sayed, A. Abo Zallat

Department of Urology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia

Objectives: To review the selection criteria and perioperative complications in patients undergoing living donor nephrectomy.

Methods: A retrospective chart review of all living donor nephrectomies performed at KFMMC during 5 years period (June 1992 to June 1997) was carried.

Results: A total of 46 donors were examined (30 males and 16 females). Mean age of donors was 30.4 years (range 18-61 years0. Siblings accounted for 52.2% of donors, parents or children 34.8% and spouses for 13%. A transcostal extraperitoneal flank approach was used for nephrectomy. There were no serious complications or mortality in this series. Serum creatinine levels were an average of 25.3 mmol/L higher in postoperative compared with preoperative values. The postoperative complications included pneumothorax requiring a chest tube in 10.8% atelectasis in 8.5% and need for blood transfusion in 2.1% of patients.

Conclusion: Living donor nephrectomy remains a valuable source for kidney transplants. Careful donor selection and surgical management are important to ensure low morbidity.

Presented at the: 11th Saudi Urological Conference King Fahd Military Medical Complex – Dhahran 24-26 February 1998 (27-29 Shawwal 1418)

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

History of renal transplantation in Saudi Arabia

Mohammed S. Abomelha

Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Renal transplantation in Saudi Arabia started as early as 30 years ago. It was in 1972 when the first documented renal transplant was performed in a Saudi patient. That renal transplant was carried out in UK by the same team who helped later on to start the first renal transplant unit in Saudi Arabia in 1979. To establish such a tertiary care unit in a country with no previous existing facilities was a quite big challenge. The big achievement was to build up a complete local facility to carry out the whole work up, operative procedures and postoperative follow up for such demanding treatment. The first renal transplant in Saudi Arabia was done on 03 April 1979 at the Riyadh Armed Forces Hospital. Two years later, the renal transplant was managed by permanent local team.

Soon after the establishment of the first renal transplant unit in the Kingdom, the magnitude of patients with end-stage-renal disease was obvious. We were aware from the beginning that the already started living related donation program will cover only small number of patients, while the majority will not be able to produce any suitable living related donors.

To cover the shortage of kidneys, a cadaveric renal donation campaign was launched after religious approval was obtained in 1982. In the same time, surplus cadaveric kidneys were utilized and used successfully with the help and cooperation of the Eurotransplant in Leiden, The Netherlands. In 1984, the legalization of renal transplant program and set-up of the National Kidney Foundation was of great importance for the advancement of medical care offered to those patients with end-stage-renal disease (ESRD).

The National Kidney Foundation (NKF) was established in 1985 aiming to coordinate nationwide utmost care to patients with ESRD. The NKF was initiated and continuously supported by HRH Prince Salman, the Governor of Riyadh. At this stage, the services for patients with ESRD had improved. Several dialysis and renal transplant centers were established.

The renal transplant program opened the door for the transplantation of other organs. Starting with heart transplant in 1986, followed by liver transplant in 1990, other organs and tissue transplant (e.g. lung, pancreas, cornea and bone marrow) were performed in several centers in Saudi Arabia. The national transplant program reached its step incorporating transplantation of different organs and the need to change the goals as well as the name of the NKF became apparent. The change was achieved in 1993 and the NKF was renamed Saudi Center for Organ Transplantation (SCOT). With the SCOT, Saudi Arabia was the first country in the region with a functioning organ transplant program.

The successful Saudi experience in organ transplantation is the result of long-term planning and the support of all governmental and medical institutions in the country. This experience is unique and it is the best of its kind outside North America and Europe.

Presented at the: 17th Saudi Urological Conference King Fahd Military Medical Complex 8-10 March 2005

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Living unrelated (commercial) renal transplantation: Early complications

Siddig Egail1,2, S. Abu Anz1,2, I. Al Oraifi1,2, A. Al Dayel1,2, E. El Sayed1,2

Departments of 1Urology and 2Nephrology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia

Background: Kidney transplantation is the optimal treatment for majority of patients with end-stage renal disease. However, due to shortage of cadaveric and living related organs supply, many Saudi patients went for commercial renal transplantation abroad. Although the high risk of complications is well established and ethically considered unacceptable, the practice of commercial transplantation has increased and placed many potential recipients at considerable personal dangers.

Patients and Methods: The short tem outcome of 126 patients who had commercial renal transplantation in various countries admitted to our center for post transplant care and follow up between June 1992 and December 2004 were retrospectively analyzed.

Results: Of the 126 patients (75 males and 51 females; mean age 39.75 + 14.6 years), 43 were transplanted in Pakistan, 33 in Philippines, 22 in India, and 19 in Egypt. The mean hospital stay was 20.7 + 12 days. At admission, the mean serum creatinine was 155.3 + 113.8 mg/L and mean serum cyclosporine 657.7 + 582.3 (range 60 to 3096) ng/ml. We found the following initial surgical complications: severe wound infection in 22 patients, lymphocele in 10, VUR in 5, and ureteric obstruction in 3 patients. Medical complications: cyclosporine nephrotoxicity in 48 patients, acute rejection in 25, CMV in 15, pneumonia in 7 and hepatitis in 7 patients. Overall 107 patients discharged from hospital with functioning graft, 8 lost their grafts and 11 (8.7%) patients died with multiple complications.

Conclusions: Commercial transplantation is associated with high rate of mortality, morbidity and serious complication. There is an urgent need to develop an appropriate system to discourage potential recipients to travel for medical unsafe procedure.

Presented at the: 17th Saudi Urological Conference King Fahd Military Medical Complex 8-10 March 2005

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Cadaveric kidneys from the donors below 5 years of age

S. Raza, K. Al Shaibani, K. Al Meshari, I. Al Ahmadi, G. Hazem

Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Body: A retrospective study was done since 1987 when the cadaveric program was started. As of September 2004, total of 330 cadaveric transplants were done. Further analyses to see the age of donor below 5 years were looked into. A total of 38 cadavers (12% of the cadavers) were found to be below the age of 5 years (52 days to 5 years). In this, they were 7 below the age of one, 23 were 1 to 3 years and 8 were between 3-5 years. There were 12 enbloc kidneys obtained from donors below the age of 3 years. Age of the recipients ranged between 3-53 years, mean age 18 years. A total of 38 transplants were done in 37 patients.

Anastomosis Technique:

  • 12 enbloc

  • 6 end-to-end anastomosis

  • 20 end-to-side anastomosis

Results:

  • 4 grafts were lost due to technical cause (I E/E, 1 = ENBLOC, 2 E/S)

  • 5 grafts were lost due to acute rejection ranging 7-60 days

  • 1 graft was lost due to PTLD (functioning graft ENBLOC)

  • 1 graft was lost on 15th day due to arterial thrombosis after the creatinine reached normal level

  • 1 graft was lost due to recurrence of original disease (SLE) after 3 years

  • 12 grafts were lost due to chronic rejection. 963 days and 3650 days mean 2158 days (5.9 years)

  • 14 grafts are still functioning, 300 days and 5110 days, mean 1991 (5.4 years)

    Two patients had ureteric complications, which were dealt by balloon dilatation and reimplantation of ureter after 7 years of the transplant. There were two deaths; one after 4 months and the other after 4 years after the transplant.

Conclusion: Results are quite encouraging though slightly lower than adult cadaveric kidneys. Many centers still do not use cadaveric kidneys below the age of 5 years. During this era of organ shortage, one should definitely use these small kidneys to increase the organ pool.

Presented at the: 17th Saudi Urological Conference King Fahd Military Medical Complex 8-10 March 2005

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Renal transplantation in children with abnormal lower urinary tract: Review of literature and introduction of a new concept

Bedeir Ali-El-Dein, Hassan Abol-Enein, Amr El-Husseini, Yasser Osman, Ahmed B. Shehab El-Din, Mohamed A. Ghoneim

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

Objective: In this retrospective study, the outcome of renal transplantation in children with abnormal lower urinary tract (LUT) is reported. In addition, pre- and post-transplant urological treatments are stated.

Methods: Between March 1981 and December 2001, 195 children (<18 years of age) received live-donor kidney transplants. Out of these, 15 (14 males and 1 female, mean age 13.5 + 3 years) had lower urinary tract disorders in the form of posterior urethral valve (PUV) with valve bladder (12) and neuropathic bladder secondary to meningomyelocele (3). These children were evaluated by voiding cystourethrogram, cystourethroscopy and cystometry. The children with PUV were run on clean intermittent catheterization (CIC) and a detrusor relaxant at least 3 months before transplantation. Augmentation ileocystoplasty and/or continent cutaneous diversion were used in 3 patients. The children were assessed for graft and patient survival and for complications compared to a group of children with normal LUT, who underwent renal transplantation during the same period.

Results: One child died in the early post transplant period due to rupture of external iliac artery. Follow up ranged from 6 months to 16 years (mean = 4.5 years). Graft survival was comparable between the group of children with and without abnormal LUT, who underwent transplantation during the same period. Patient survival, mean serum creatinine and creatinine clearance were also comparable in both groups. The group with abnormal LUT showed a higher incidence of urinary fistula (3/14) and recurrent UTI and/or bacteremia (4/14). Otherwise both groups were comparable.

Conclusions: Renal transplantation in children with abnormal LUT is feasible with good results. Pre- and post-transplant urologic management is critical for a successful outcome. A high incidence of urological and infectious complications should be anticipated and properly managed.

Presented at the: 16th Saudi Urological Conference King Faisal Specialist Hospital & Research Centre 2-4 March 2004 (11-13 Muharram 1425)

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Renal transplant in pediatric patients with body weight of less than 15 kg

Sayed Raza, K. Al Shaibani, K. Al Meshari, I. Al Ahmadi, G. Hazem

Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Introduction: A total of 942 transplants were done in KFSH & RC from 1981 until September 2004. Out of this, pediatric transplants were 166. The pediatric age group is up to the age of 17 years. Among this group, there were 76 living related and 90 cadaveric kidney recipients. An analysis was made among the pediatric age group and found that there were 43 recipients below the weight of 15 kg and 33 transplants were done in them. The age of the cadavers ranged between 1 year and 45 years. There were two kidneys from 1 year old, 2 kidneys from 2 years old and one kidney from a 6-year-old cadaver. The follow up from 2 months to 155 months mean of 39 months.

Cold ischemia time in CAD 1197 (960-1397)

Cold ischemia time in LRT 223 (199-307)

M. Matches CAD 4.6 (3-6)

M. Matches LRT 2 (0-5)

Results: Three kidneys were lost. One on the 3rd post-op day rejection and rupture. The other two were lost at 30 and 50 days post-op due to rejection. No kidney was lost due to technical reason. There were 6 episodes of rejection in 5 recipients, all were in cadaveric recipients. There were two ureteric complications. One was a urinary leak that was fixed soon and other developed stenosis after 7 years, which was successfully dilated by a balloon. There was one renal artery thrombosis that was explored and re-anastomosis within two hours. Another renal artery stenosis was noted after 6 weeks not at anastomosis that was successfully dilated by balloon angioplasty. Six patients had urinary tract infection. No patient died.

Conclusion: It is possible to transplant young pediatric patients with good results.

Presented at the: 17th Saudi Urological Conference King Fahd Military Medical Complex 8-10 March 2005

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Living unrelated (commercial) renal transplantation: Early complications

Sami Abu Anz1,2, S. Egail1,2, A. Al Gahtani1,2, I. Al Oraifi1,2, A. Al Dayel1,2, E. ElSayed1,2, S. Al Zahrani1,2, M. Najjar1,2

Departments of 1Urology and 2Nephrology, King Fahd Military Medical Comples, Dhahran, Saudi Arabia

Background: Kidney transplantation is the optimal treatment for majority of patients with end-stage renal disease. However, due to shortage of cadaveric and living related organs supply, many Saudi patients went for commercial renal transplantation abroad. Although the high risk of complication is well established and ethically considered unacceptable, the practice recipients of considerable personal dangers.

Patients and Methods: The short term outcome of 188 patients who had commercial renal transplantation in various countries admitted to our center for post transplant care and follow up between June 1992 and December 2006 were retrospectively analyzed.

Results: Of the 188 patients (99 males and 88 females; mean age 39.75 + 27 years, 84 were transplanted in Pakistan, 46 in Philippines, 22 in India and 27 in Egypt. The mean hospital stay was 20.7 + 12 days. At admission, the mean serum creatinine was 155.3 + 113.8 ug/l and mean serum cyclosporine 657.7 + 582.3 (range 60 to 3096) ng/ml. We found the following initial surgical complications: severe wound infection in 33 patients, lymphocele in 13, VUR in 5 and ureteric obstruction in 5 patients. Medical complications: cyclosporine nephrotoxicity in 49 patients, acute rejection in 34, CMV in 18, pneumonia in 10 and hepatitis in 7 patients. Overall, 165 patients discharged from hospital with functioning graft, 9 lost their grafts and 14 (7.5%) with multiple complications.

Conclusions: Commercial transplantation is associated with high rate of mortality, morbidity and serious complication. There is an urgent need to develop an appropriate system to discourage potential recipients to travel for medical unsafe procedure.

Presented at the: 19th Saudi Urological Conference King Khalid University Hospital – Riyadh 26 February – 01 March 2007

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Experience of renal transplantation at North West Armed Forces Hospital of Tabuk

A. Albalawi, M. El-Bahnasawy, B. Saleh, M. Hassan, E. Albalawi, A. Howiti, M. Zakaria

Department of Urology, North West Armed Forces Hospital, Tabuk, Saudi Arabia

Objective: Renal transplantation continues to be the best replacement therapy for patients with chronic renal failure. Our aim is to evaluate our own experience at Tabuk in kidney transplantation.

Patients and Methods: All the charts of 112 patients who received kidney transplant in our hospital between 1992 and end of 2008 were reviewed. Early and postoperative complications together with their management, immunosuppressive regimens adopted and the early and current graft functions were reviewed.

Results: The mean time from starting dialysis to transplant was 6 years. There were 41 cadaver donor (CAD) and 71 living related donor (LRD) transplants. All patients received triple drug immune-suppression. Patients with delayed graft function received anti-thymocyte globulin instead of cyclosporine (anti-TAG + FK506 + MMF + PREDNISONE) until recovery of graft function. 5 year graft survival was as follows: all transplants 76.1%; LRD transplants 82.2%, CAD transplants 73.5%. The commonest cause of graft loss was chronic rejection. The 5 year patient survival was as follows: all transplants 93.5%, LRD transplants 96.0%, CAD transplants 93.0%, respectively.

Conclusion: The overall results of kidney transplantation in our center are comparable to those published from other centers in Saudi Arabia and abroad.

Presented at the: 21st Saudi Urological Conference North West Armed Forces Hospital – Tabuk 14-16 April 2009

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Synthetic extra-anatomic ureter in a post transplant ureter obstruction

Abdulrahman Babaeer1,2, Abdullah Alkhayal1,2, Nasser Albqami1,2

Departments of 1Surgery and 2Urology, King Saud University, Riyadh, Saudi Arabia

Ureteric stricture is the most common urologic complication after renal transplant, occurs at a rate of 2.7%. It is most commonly due to ischemic injury to the ureter, but can also be due to secondary causes. Most of the strictures occur at the level of the distal ureter. Initial approach is endourologic by inserting a percutaneous nephrostomy tube and antegrade balloon dilatations. If this fails, open surgical management with ureteroneocystostomy or ureteroureterostomy to the native ureter is the treatment of choice for complicated cases. However, such procedures are not always successful. If open surgical management fails, the options will be either permanent nephrostomy tube or transplant nephrectomy. Recently, extra-anatomic ureters (DETOUR system) have been described in the literature. A silicone coated polytetraflourethelene tube that bypass the ureter to the bladder through a subcutaneous route. Initially, it was indicated in patients with ureteral obstruction secondary to pelvic malignancy. Then the indication was extended to involve other benign conditions. Only 7 cases have been reported in the literature where the DETOUR system has been done in post transplant ureteral obstruction. We report a patient who developed a ureteric stricture 6 months after transplant and failed endourologic and open surgical management. He was kept on percutaneous nephrostomy tube for 3 years complicated by recurrent urinary tract infections. In May 2008, the patient had the DETOUR system done. He did not have urinary tract infections since then and his renal function remained at baseline.

Presented at the: 22nd Saudi Urological Conference King Faisal Specialist Hospital and Research Centre 15-18 March 2010

Urol Ann. 2016 Apr;8(Suppl 2):S189–S197.

Ureteral complications of renal transplantation

I. A. Al Oraifi, M. A. Aggamy

Department of Urology, King Fahd Specialist Hospital, Dammam, Saudi Arabia

Introduction: Ureteral complications occur in 3–14% of renal transplantations. Our objective was to review the ureteral complications of our living related renal transplantation cases and to relate that to open and laparoscopic donor nephrectomy.

Method: We reviewed our cases of renal transplantation which were done between September 2008 and November 2010 retrospectively who had a living donor nephrectomy whether open or laparoscopic. All ureters were implanted using the extra vesical Lich-gregoir technique and a double J stent was inserted for 2–3 weeks.

Results: 110 renal transplantations were performed in our center. Of the living related transplants 57 (50 adult and 7 pediatric recipients); 31 (54.3%) were done laparoscopically while the rest 26 (45.6%) were done by open surgery (because we didn’t start laparoscopy at the beginning of our transplant program). Three (5.2%) of the living related recipients had ureteral complications. All of them had received kidneys retrieved by open nephrectomy and none of them were in the laparoscopy group, two of these patients had stenotic distal ureters which were managed successfully endourologically and the third case (1.7%) had severe distal ureteric stenosis and it was managed by open uretero-cystostomy.

Conclusion: The incidence of ureteral complications in our series is within the reported international range.

Presented at the: 23rd Saudi Urological Conference King Fahd Specialist Hospital – Dammam 21-24 February 2011

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