title: A single-center experience of overseas kidney transplant for immunologically high-risk patients.
abstract: OBJECTIVE
  We report our experience in treating Mongolian patients transferred to our center in Korea to undergo kidney transplants, including immunologically high-risk patients.
  
  
  METHODS
  Between September 2009 and February 2013, thirty-three Mongolian patients underwent kidney transplants at our center with the approval of the Korean Network for Organ Sharing. Their clinical data were retrospectively collected and analyzed.
  
  
  RESULTS
  The mean age of the transplant recipients was 38.8 ± 10.5 years, and the causes of end-stage renal disease were glomerulonephritis (5), diabetes mellitus (2), hypertension (3), and unknown (25). These cases included ABO incompatibility, high levels of sensitization, and retransplant, at frequencies of 9, 12, and 9. Basiliximab (30) or antithymocyte globulin (2) was administered as the induction therapy, and combination regimens of plasmapheresis with or without intravenous immunoglobulins and/or rituximab were used in some high-risk patients. The mean follow-up after kidney transplant was 12.87 ± 11.7 months. During the follow-up, antibody-mediated rejection and graft failure occurred in 2 patients. In addition, cytomegalovirus infection, calcineurin inhibitor toxicity, and BK viremia developed in 1 patient each. The mean estimated glomerular filtration rates at 1, 6, and 12 months after kidney transplant were 88.2 ± 26.9 mL/min/1.73 m2, 67.5 ± 14.9 mL/min/1.73 m2, and 63.9 ± 21.1 mL/min/1.73 m2. In addition, subgroup analysis revealed that ABOincompatible and immunologically high-risk recipients had comparable renal function status during the follow-up.
  
  
  CONCLUSIONS
  We found that an overseas kidney transplant program in Korea could be conducted safely, even in high-risk patients. Therefore, a proper cooperation and transfer system for these high-risk patients between neighboring countries might help in providing improved medical care in this setting.
authors.affiliation: From the Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Jung
authors.forename: Kwan Tae
authors.initials: KT
authors.lastname: Park
authors.forename: Heungman
authors.initials: H
authors.lastname: Jun
authors.forename: Su Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Kim
authors.forename: Sang-Kyung
authors.initials: SK
authors.lastname: Jo
authors.forename: Wonyong
authors.initials: W
authors.lastname: Cho
authors.forename: Hyoung Kyu
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003888:Desensitization, Immunologic / Q000379:methods; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007391:International Cooperation; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D057193:Medical Tourism; D008875:Middle Aged; D008986:Mongolia; D010348:Patient Care Team; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents