RESUMEN
Renal transplantation that offers a good quality of life still is not performed by the majority of countries of black Africa. We started a pilot project of renal transplantation in Ivory Coast 2 years ago. The present paper reports the preliminary results, difficulties related to the program, and perspectives regarding its expansion. Ten living related kidney transplantations have been performed over a 2-year period. Recipients and their respective donors were male. The mean age of the recipients was 42.8 years (22-57), and the mean age of the donors was 29.4 years (22-43). The mean number of mismatches was 3.2 (0-6). None was immunized. Recipients and donors were all EBV IgG positive and CMV IgG positive. All but 1 case were induced with basiliximab. The mean graft and patient survival time was 16.6 months (6-26). The mean cold ischemic time was 2.27 hours (1-3.32). The mean serum creatinine at discharge was 241.87 µmol/L (115.18-1063.2), at 6 months was 117.20 µmol/l (95.6-139.9), at 12 months was 104.55 µmol/L (62.02-132.9), and at 24 months was 104.55 µmol/L (62.02-132.9). The mean cyclosporine through level (C0) at 6 months was 137.57 ng/mL (70-366), at 12 months was 117.33 ng/mL (62-197), and at 24 months was 78 ng/mL. The mean cyclosporine 2-hour post-administration concentration levels (C2) at 6 months was 764.9 ng/mL (430-1421), at 12 months was 937.17 ng/mL (483-1292), and at 24 months was 690.66 ng/mL (488-853). Main complications were sepsis, adenovirus hemorrhagic cystitis, new-onset diabetes after transplantation, delayed graft function, polycythemia, and cytomegalovirus infection. No clinical rejection was diagnosed over the 2-year period. Patient and graft survival was 100% at a mean post-transplantation time of approximately 16.6 months.
Asunto(s)
Trasplante de Riñón/métodos , Insuficiencia Renal Crónica/cirugía , Adulto , Côte d'Ivoire , Ciclosporina/administración & dosificación , Infecciones por Citomegalovirus/tratamiento farmacológico , Selección de Donante , Femenino , Supervivencia de Injerto , Humanos , Inmunosupresores/administración & dosificación , Trasplante de Riñón/estadística & datos numéricos , Donadores Vivos , Masculino , Persona de Mediana Edad , Selección de Paciente , Proyectos Piloto , Calidad de Vida , Adulto JovenRESUMEN
BACKGROUND: The outcomes of transplanted kidney recipients from "transplant tourism" have been reported to be alarming. The present study was an attempt to examine the results of renal patients from the Ivory Coast transplanted abroad returning home for follow-up. PATIENTS AND METHODS: This retrospective analysis includes renal patients from the Ivory Coast transplanted abroad between 1995 and 2009 and followed up by our nephrology clinic. We collected pre- and posttransplant parameters for statistical analyses. RESULTS: The 16 patients had a median age of 48 years (range = 32.5-53.75). The median age of kidney donors was 44 years (range = 30.75-51.25). Initial kidney disease was hypertension in 10 patients (62.5%) and diabetes in three patients (18.8%). They received organs from living donors (37.5% related [LRD] and 37.5% unrelated [LURD]). Initial immunosuppression consisted of induction (72.7%), tacrolimus (75%), and mycophenolate mofetil (100%). Two patients (12.5%) experienced late acute rejections, resulting in graft loss. The overall graft survival was 93% at 1 year and 80% at 5 years. Five patients died over the study period, corresponding to an overall mortality rate of 9.25/100 patient-years. The overall median patient survival was 6.25 years (range = 4.19-7.58). Patient survivals at 1 and 5 years were 93% and 53%, respectively. No factors seemed to influence survival (either graft or patient) upon multivariate analysis. Comparison between LRD and LURD recipients revealed no statistical difference among posttransplant characteristics and survivals. CONCLUSION: Mortality of renal patients from the Ivory Coast transplanted abroad is high. Financial exhaustion after transplantation renders follow-up precarious. A local kidney transplantation program in the Ivory Coast appears more urgent than ever.
Asunto(s)
Rechazo de Injerto/etiología , Supervivencia de Injerto , Trasplante de Riñón/efectos adversos , Turismo Médico , Programas Nacionales de Salud , Evaluación de Procesos y Resultados en Atención de Salud , Adulto , Distribución de Chi-Cuadrado , Côte d'Ivoire , Quimioterapia Combinada , Femenino , Rechazo de Injerto/mortalidad , Humanos , Inmunosupresores/uso terapéutico , Estimación de Kaplan-Meier , Trasplante de Riñón/mortalidad , Donadores Vivos , Masculino , Turismo Médico/estadística & datos numéricos , Persona de Mediana Edad , Evaluación de Necesidades , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 65-year-old man who received a deceased renal allograft in September 2001. The donor of the allograft was a 54-year-old hypertensive man who expired from intracerebral hemorrhage. Atheroma with hard plaques was present in both renal arteries and aortic patches. After vascular anastomosis and clamp release, the allograft recoloration was inadequate, and the patient remained anuric. Computerized tomography scan demonstrated disseminated infarction areas, suggesting cholesterol emboli, which was confirmed later by a graft biopsy. As approximately 50% of the renal parenchyma was perfused, graft nephrectomy was not indicated and dialysis was restarted. Diuresis was over 3000 ml/day and serum creatinine decreased and stabilized at 360 micromol/L by the 32nd postoperative day. The allograft supported the patient for only two years, and he eventually was successfully retransplanted in June 2003. We believe that delayed graft function due to cholesterol emboli disease may be reversible if areas of infarction are not too large.
Asunto(s)
Embolia por Colesterol/cirugía , Trasplante de Riñón/efectos adversos , Adulto , Anciano , Cadáver , Carcinoma Papilar/cirugía , Embolia por Colesterol/diagnóstico por imagen , Embolia por Colesterol/patología , Humanos , Neoplasias Renales/cirugía , Persona de Mediana Edad , Donantes de Tejidos , Tomografía Computarizada por Rayos X , Trasplante Homólogo , Resultado del TratamientoRESUMEN
Contexte : La néphropathie chronique d'allogreffe (NCA) représente la première cause de perte de greffe chez le transplanté rénal. Objectif : Comparer les effets à long terme des IEC et des IC sur la fonction rénale des transplantés rénaux au CHU de Montpellier Patients et Méthodes : De 1986 à 2000, tous les transplantés rénaux qui ont été traités par les IEC ou les IC ont recrutés dans une étude rétrospective. Les patients dont la durée de prescription a été plus d'une année ont été inclus dans l'étude. Pour chaque patient recruté, des facteurs immunologiques et non immunologiques ont été répertoriés. Résultats : 41 patients ont été recrutés pendant la période d'étude, dont 21 étaient traités par IEC et 20 par IC. La prévalence globale de la NCA était de 36.6%. Elle était survenue après un délai de 4094.452 + 148.50 jours. Quand on considère le traitement, la prévalence de la NCA était identique dans les 2 groupes (38.09% contre 35%), tout comme les fonctions rénales (146.06 + 51.91 contre 155 + 75.48 mmol/l), respectivement pour les IEC et les IC. Lorsque seuls les patients qui ont présenté un rejet chronique sont considérés pour chaque groupe, les fonctions de greffon étaient aussi identiques 198.57 + 53.6 contre 229 + 77.64 mmol/l) tout comme le délai de survenue du rejet chronique (4107 + 1580 contre 4123 + 1293 jours), respectivement pour les IEC et les IC. Conclusion : La prévalence de la NCA était identique dans les groupes. L'évolution de la NCA n'a pas été aussi différente dans les deux groupes