title: Commercial transplants in local Pakistanis from vended kidneys: a socio-economic and outcome study.
abstract: 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.
authors.affiliation: Sindh Institute of Urology and Transplantation (SIUT), Civil Hospital, Karachi, Pakistan. info@siut.org
authors.forename: Syed Adibul Hasan
authors.initials: SA
authors.lastname: Rizvi
authors.forename: Syed Ali Anwar
authors.initials: SA
authors.lastname: Naqvi
authors.forename: Mirza Naqi
authors.initials: MN
authors.lastname: Zafar
authors.forename: Farida
authors.initials: F
authors.lastname: Mazhar
authors.forename: Rana
authors.initials: R
authors.lastname: Muzaffar
authors.forename: Rubina
authors.initials: R
authors.lastname: Naqvi
authors.forename: Fazal
authors.initials: F
authors.lastname: Akhtar
authors.forename: Ejaz
authors.initials: E
authors.lastname: Ahmed
mesh_terms: 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