Evolution of renal transplantation in India over the last four decades

Abraham, Georgi; John, George T.; Shroff, Sunil; Fernando, Edwin; Reddy, Yogesh N V

doi:10.1093/ndtplus/sfp178

Cited by 57 publications

(56 citation statements)

References 11 publications

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“…When the deceased donor and ABO incompatible transplantation is not practiced/available at all transplant centers in India, KPD is a more viable legal option. 11,[17][18][19][20] In developing countries like India, HLA matched KPD would result in less immunosuppression and less expenses, lower infective morbidity and better survival. 12 This finding is relevant in the context of wider participation from compatible spousal donors.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Kidney Paired Donation Transplantations with Living Related Donor Kidney Transplantation: Implications for National Kidney Paired Donation Program

et al. 2013

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Background: Kidney Paired Donation (KPD) is a rapidly growing modality for facilitating living related donor kidney transplantation (LRDKTx) for patients who are incompatible with their healthy, willing, and living donors. Data scarcity on the outcome of KPD versus LRDKTx prompted us to review our experience. Materials and methods: This was a singlecenter study of 224 patients on regular follow-up, who underwent LRDRTx from January 2010 to June 2012 at our institute. The aim of this study was to compare short-term graft survival, patient survival and rejection rates of KPD (group 1, n ¼ 34) with those of LRDKTx (group 2, n ¼ 190). All the recipients received triple immunosuppression and thymoglobulin induction in KPD group. Kaplan-Meier curves were used for survival analysis. In group 1, mean recipient age was 35.5 AE 13.2 years, 29 were men and mean donor age was 44.4 AE 8.17 years, 10 were men. In group 2, mean recipient age was 29.1 AE 10 years, 155 were men and mean donor age was 47.5 AE 9.69 years, 74 were men. Mean human leukocyte antigen (HLA) matching in group 1 and 2 was 1 versus 3.2 (p < 0.05). Results: One-and two-year patient survival showed no significant difference between the two groups (97.1%, 97.1% vs. 96.2%, 94.8%, respectively, p ¼ 0.81). Death-censored graft survival also showed no significant difference between the two groups (97.1%, 97.1%, vs. 97.6%, 97.6%, p ¼ 0.73). Acute rejection incidence was also similar (8.7% vs. 9.9%, p > 0.62). Conclusions: Our study showed similar graft survival, patient survival and rejection rates of KPD versus LRDKTx over 2 years post-transplantation, encouraging the use of this approach for national KPD program.

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Section: Discussionmentioning

confidence: 99%

Comparison of Kidney Paired Donation Transplantations with Living Related Donor Kidney Transplantation: Implications for National Kidney Paired Donation Program

et al. 2013

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“…The percentage of children getting transplant thus varies from 3.9% in Sudan to 75% in Kuwait and the overall transplant rates in children are <15/year in a majority of the countries (Table 1). Transplantation is mainly performed in private centers where the costs range from $10 000-20 000 (38) together with a yearly immunosuppression cost of $3000-4000/year (39). High costs of drugs often lead to noncompliance, for example, 25% in Chile and 23% in Egypt (2,18,37).…”

Section: Economic Issuesmentioning

confidence: 99%

“…The logistic issues vis-a-vis cost of travel, reallocation and lodging in the preand posttransplant period creates financial and logistic problems where many families shy away from transplantation (26,29,39,40). In general poor access, nonavailability and high costs render transplantation beyond the means of the majority.…”

Section: Logistic Issuesmentioning

confidence: 99%

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Pediatric Kidney Transplantation in the Developing World: Challenges and Solutions

Rizvi

Sultan

Zafar

et al. 2013

American Journal of Transplantation

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The prevalence of pediatric RRT and transplantation are low in developing countries, 6-12 and <1 to 5 per million child population (pmcp), respectively. This is due to low GDP/capita of <$10 000, government expenditure on health of <2.6-9% of GDP and paucity of facilities. The reported incidence of pediatric CKD and ESRD is <1.0-8 and 3.4-35 pmcp, respectively. RRT and transplantation are offered mostly in private centers in cities where HD costs $20-100/session and transplants $10 000-20 000. High costs and long distance to centers results in treatment refusal in up to 35% of the cases. In this backdrop 75-85% of children with ESRD are disfranchised from RRT and transplantation. Our center initiated an integrated dialysis-transplant program funded by a community-government partnership where RRT and transplantation was provided ''free of cost'' with life long follow-up and medication. Access to free RRT at doorsteps and transplantation lead to societal acceptance of transplantation as the therapy of choice for ESRD. This enabled us to perform 475 pediatric transplants in 25 years with 1-and 5-year graft survival of 96% and 81%, respectively. Our model shows that pediatric transplantation is possible in developing countries when freely available and accessible to all who need it in the public sector.

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“…A similar successful partnership between the Government and the private sector has recently been reported in India. 26 There are tremendous opportunities to correct disparities in kidney disease and transplantation worldwide, but it is important to recognize that funding of ESRD treatment should be associated with funding for early detection and prevention of the progressive kidney diseases that lead to ESRD. Comprehensive programs should include community screening and prevention of CKD, especially in high-risk populations, as well as dialysis and transplantation for ESRD.…”

Section: The Role Of Kidney Transplantationmentioning

confidence: 99%