Kidney transplantation in Libya: a North African and Middle Eastern perspective.
OBJECTIVE
In August 2004, a national organ transplant program utilizing the latest policies, procedures, and protocols was begun in Libya. During the first year of the program, 50 kidney transplantations from living donors were performed.


METHODS
Forty-nine patients (aged 7 to 65 years) received kidneys from living-related donors (aged 19 to 54 years), and 1 husband received a kidney from his wife. Donor selection was based on human leukocyte antigen compatibility. Renal failure was due to chronic glomerulonephritis in most patients, diabetes in 5 adults, systemic lupus erythematosus in 2 adults, and congenital anomalies in 2 children. Sixteen patients matched the human leukocyte antigens of their donors, 28 matched 1 haplotype, and 6 did not match any haplotype. Immunosuppression was accomplished with methylprednisolone and basiliximab. Maintenance therapy was with mycophenolate mofetil, cyclosporine, and prednisone. The latter was completely discontinued 1 month after transplantation. In patients with resistant hypertension, unilateral native nephrectomy was carried out during transplantation. Donor nephrectomy was performed through an open mini-incision using a Thompson retractor.


RESULTS
At the time of this writing, 49 patients are alive and well, and 48 of them have had functioning kidneys for 10 to 22 months. Three patients had acute rejections that were successfully treated with methylprednisolone (n=1) or methylprednisolone and antithymocyte globulin (n=2). At the time of this writing, all 46 adults and 2 pediatric recipients have excellent renal function and are living normal lives.


CONCLUSIONS
In terms of patient survival and quality of life, transplantation is superior to dialysis. Also, transplantation is less expensive than dialysis. In Libya, establishing an active and successful transplant program with early steroid withdrawal has brought many benefits to patients and their families and great financial savings to the government. Our program hopefully will provide a model for similar programs in Asia and Africa and encourage local governments to legalize organ procurement from cadaveric donors.
Ehtuish
Ehtuish F
EF
Organ Transplant Center, Tripoli Central Hospital, Tripoli, Libya, and Department of Surgery, Drexel University Medical College, Philadelphia, PA, USA.
Abouna
George M
GM
Shebani
Abdul-Hafid A
AH
Abdulmola
Tamer S
TS
Shawesh
Tayeb Z
TZ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000208:ethnology* / Q000706:statistics & numerical data* / Q000639:trends; D008002:Libya; D019520:Living Donors; D008297:Male; D008875:Middle Aged
D007166:Immunosuppressive Agents