Pediatric renal transplantation in Pakistan

Rizvi, S. A. H.

doi:10.1016/s0041-1345(00)00932-5

Cited by 11 publications

(25 citation statements)

References 3 publications

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“…In developing countries the main resource for renal transplantation are living donors due to absence of deceased donor programs (3,4). This emphasizes the need for careful evaluation of donors to ensure their well-being after uninephrectomy.…”

Section: Introductionmentioning

confidence: 99%

Health Status and Renal Function Evaluation of Kidney Vendors: A Report from Pakistan

Naqvi

Rizvi

Zafar

et al. 2008

American Journal of Transplantation

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Section: Introductionmentioning

confidence: 99%

Health Status and Renal Function Evaluation of Kidney Vendors: A Report from Pakistan

Naqvi

Rizvi

Zafar

et al. 2008

American Journal of Transplantation

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“…[20][21][22] Socioeconomic factors are also important in affecting the quality of life of hemodialysis patients and their compliance. [17][18][19]23 Most of our patients belong to low socioeconomic groups, and lack of family was found to contribute to noncompliance in around 15% of patients in this study. This is also directly linked to the lack of hygienic lodging and boarding facilities near the dialysis center.…”

Section: Discussionmentioning

confidence: 57%

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Mazhar

Nizam²,

Fatima³

et al. 2017

Exp Clin Transplant

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Objectives: The prevalence of end-stage renal disease is increasing worldwide. It is also one of the main health problems in Pakistan. Currently, hemodialysis represents the main mode of treatment for patients with end-stage renal disease in this country. Despite 24-hour free dialysis at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan), a significant number of patients do not turn up for regular dialysis or miss regular sessions of dialysis. We conducted this study to identify and highlight the factors leading to poor compliance with regular hemodialysis treatment despite free dialysis treatment offered at our center. Results: Despite 24-hour dialysis facilities, the patient drop-out rate (779; 18%) was high. In addition, a significant minority of patients (610; 13.4%) was erratic in adherence to maintenance hemodialysis schedules, with > 2 missed appointments. The mean age of these 610 patients was 33.4 ± 7.4 years, and 345 patients (57%) were males. The main factors leading to poor compliance included cost of travel (33.2%), lack of affordable lodging and boarding facilities near dialysis center (30.9%), long distances from dialysis center (20.1%), and lack of family support (15.6%).Conclusions: This study shows that there is significant drop-out and poor compliance rates for regular dialysis despite free dialysis facilities.

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“…To maintain this large number of patients a number of economizing strategies were introduced to reduce cost without compromising quality. Basic hemodialysis machines were used which costs 30% less than more sophisticated units, plus inhouse preparation of dialysis fluid by selfimporting bulk reagents, dialysis reuse on automated systems except Hepatitis B positive patients and the use of generic immunosuppressants which are 30% cheaper than patents (42).…”

Section: Overcoming the Challenges In Developing Countriesmentioning

confidence: 99%

“…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.…”

Section: Rrt At the Doorstep Of Patientsmentioning

confidence: 99%

“…Generics being 30% cheaper with acceptable bioequivalence and good outcomes become the mainstay of treatment (42). We introduced pharmacokinetic profiling of cyclosporine on 4th or 5th day of transplant by an abbreviated area under the curve (AUC) to determine the adequacy of the drug exposure (42). AUC undertaken in 386 children on 8 mg/ kg/body weight showed adequate levels (range 6000-8000 ng/ml/h) in 155 (40%), high in 34 (9%) and low in 197 (51%) of the children.…”

Section: Societal Acceptance Of Rrt and Transplantationmentioning

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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Pediatric renal transplantation in Pakistan

Cited by 11 publications

References 3 publications

Health Status and Renal Function Evaluation of Kidney Vendors: A Report from Pakistan

Health Status and Renal Function Evaluation of Kidney Vendors: A Report from Pakistan

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Pediatric Kidney Transplantation in the Developing World: Challenges and Solutions

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