Living related renal transplants with lifelong follow-up. A model for the developing world

O papel global do transplante renal

“…7 In New Zealand, Maori and Pacific Island recipients of deceased donor transplants have a 50% eight-year graft survival compared to 14 years for non-indigenous recipients, in part due to differences in mortality. 8 By contrast, despite a poor resource environment, Rizvi et al report one and five-year survival rates of 92 and 85%, respectively, among 2,249 living related kidney transplants in Pakistan, 9 whilst in Mexico, 90 and 80% one-year survival for living and deceased donor kidney transplants were reported among 1,356 transplants performed at a single centre. 10 However, while it is possible to achieve such excellent long-term results, most patients and their families in poor resource environments are not able to afford the high cost of immunosuppressant and antiviral medications needed to reduce the risk of graft loss and mortality.…”

Pediatric Kidney Transplantation in the Developing World: Challenges and Solutions

“…Having overcome the economic issues the institute focus was on logistics and accessibility. This was achieved by establishing satellite dialysis centers in the outskirts of the city, as well as at 500 and 2000 km from the center where patients could be dialyzed and referred for transplantation (41,42). Presently of the 700 patients dialyzed daily some 300 are treated at six satellite centers of the institute.…”

“…Annually, over 1000 patients receive 200 000 dialysis sessions and 350-550 receive transplants, 10-15% being children. About 40% of the patients come from other provinces of the country as far as 2000 km (38,41). To maintain this large number of patients a number of economizing strategies were introduced to reduce cost without compromising quality.…”

“…To facilitate transplanted children and ensure 100% follow-up, the medical social department provides travel costs and free accommodation to about 5-19% of the patients each year. Posttransplant immunosuppressive drugs are provided free for life and for 3 months at a time for patients living in far off places (38,41).…”

“…All services are provided ''free'' without consideration of caste, color, creed or religious affiliation. The aim is to provide comprehensive services; therefore all facilities have been developed under one roof to include radiology, laboratory, nuclear medicine and rehabilitation and teaching facilities (41).…”