Commercial transplants in local Pakistanis from vended kidneys: a socio-economic and outcome study.
Donor shortage and absence of transplant law lead to unrelated commercial transplants in Pakistan. We report the socio-economic and outcome parameters of 126 local recipients of unrelated kidney vendor transplants presenting to our institute between 1997 and 2007. Their outcome was compared with 180 recipients of living-related donor transplants matched for age, gender and transplant duration as controls. Age of commercial recipients was 35.63 +/- 11.57 years with an M:F ratio of 2.4:1. Majority (92%) were transplanted in northern Pakistan paying US$7271 +/- 2198. All were educated with 50% being graduates or above and rich earning a monthly salary of US$517 +/- 518 with 44% earning >US$500. Comparison of commercial recipients with controls showed high comorbidities 35 (28%) vs. 14 (8%) (P = 0.0001) with diabetes, hepatitis-C and cardiovascular diseases. Donor age was 29.97 +/- 6.16 vs. 32.63 +/- 9.3 years (P = 0.035). Biologic agents induction in 101 (80%) vs. 14 (8%) (P = 0.0001), acute rejections in 42 (33%) vs. 31 (17%) (P = 0.005), 1-year creatinine 1.84 +/- 1.28 vs. 1.27 +/- 0.4 mg/dl (P = 0.0001), surgical complications 28 (22%) vs. 14 (8%) (P = 0.001), tuberculosis 14 (11%) vs. 6 (6%) (P = 0.007), acute hepatitis 20 (16%) vs. 3 (2%) (P = 0.0001), cytomegalovirus 33 (26%) vs. 21 (11%) (P = 0.001) and recurrent urinary tract infection 35 (28%) vs. 30 (16%) (P = 0.034). Overall 1- and 5-year graft survival was 86% and 45% vs. 94% and 80%, respectively (P = 0.00001). Total deaths were 34 (27%) vs. 12 (6.0%) (P = 0.001). In conclusion, recipients of the vended kidneys are poor candidates, educated, rich and often self-selecting. Their outcome is poor, which will leave them poorer still and back to dialysis if not death.
Rizvi
Syed Adibul Hasan
SA
Sindh Institute of Urology and Transplantation (SIUT), Civil Hospital, Karachi, Pakistan. info@siut.org
Naqvi
Syed Ali Anwar
SA
Zafar
Mirza Naqi
MN
Mazhar
Farida
F
Muzaffar
Rana
R
Naqvi
Rubina
R
Akhtar
Fazal
F
Ahmed
Ejaz
E
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000601:surgery*; D016030:Kidney Transplantation / Q000191:economics* / Q000276:immunology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012959:Socioeconomic Factors; D009927:Tissue and Organ Procurement / Q000191:economics; D016896:Treatment Outcome