Background Outcomes for the pediatric kidney transplant program in Johannesburg (1984‐2003) were found to be suboptimal. In this study, we compared (a) early (era 1:1984‐2003) to contemporary (era 2:2004‐2017) outcomes and (b) compared contemporary outcomes between the public and private sector hospitals in our program. Methods We conducted a retrospective record review of all pediatric (<18 years) KA transplants performed in our kidney transplant program at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC) from 2004 to 2017. We collected the following data per site: number of recipients, transplants performed, mean follow‐up time, and grafts lost; per recipient: age at time of transplant, sex, self‐reported population group; transplant history; donor type; etiology of ESKD; recipient and graft survival. Outcomes for era 1 were based on data published on our kidney transplant program, based at CMJAH. Results At CMJAH (public sector), there was no improvement in recipient and graft survival over time. In the contemporary analysis, 1‐, 5‐, and 10‐year recipient survival, as % (95% CI) was 93 (84‐97); 76 (64‐84); 59 (44‐70) for CMJAH, and 98 (90‐99); 95 (86‐99); 82 (54‐94) for WDGMC (private sector). Similarly, 1‐, 5‐ and 10‐year graft survival was 75 (63‐84); 55 (42‐66); 36 (24‐49) for CMJAH, and 96 (87‐99); 84 (73‐91); 64 (48‐76) at WDGMC. Conclusion Contemporary outcomes for the pediatric kidney transplant program at WDGMC are comparable to outcomes achieved in middle‐ and high‐income settings. However, outcomes at CMJAH are suboptimal, reflecting numerous health system, infrastructural and human resource challenges.
Background Despite serious health risks having been described, traditional enemas are still often used in African traditional medicine. We aim to report two cases of complications secondary to traditional enemas, to illustrate how severe the injuries can be, and to describe the use of a Swenson type endoanal pull-through and a posterior sagittal anorectoplasty (PSARP) as surgical options. Case Description A 2-year-old girl presented with a necrotic rectum after a traditional enema administration. At admission, she required a laparotomy, colostomy fashioning, and extensive debridement of her rectum and perineum. She subsequently had a pull-through of the descending colon using a PSARP approach, a covering loop ileostomy, and a Malone Antegrade Continence Enema. The ileostomy was reversed at the age of 3 years of age and she is now clean with rectal washouts.The second case was a one- and a half-year-old boy with full-thickness burns to the perineum and rectum secondary to a hot-water enema. A colostomy was initially brought out and pulled through 7 months post the initial surgery. He is now growing well and is fully continent to stools. Conclusions The potential complications associated with the practice of administering at-home enemas can be quite devastating. A transanal pull-through and a PSARP have been proven to be successful techniques in patients who have suffered rectal burns due to traditional enemas.
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