Living unrelated renal transplant : outcome and issues

Living unrelated transplantation (LURT) is emerging as a practical option in renal transplantation due to shortage of living related and cadaver donors. We report a six-years (December 1991 to December 1996) follow-up of 60 LURT patients. The majority of these patients (95 %) were transplanted outside the Kingdom of Saudi Arabia ; 37 in India, 14 in Egypt, five in the USA and one in Pakistan. Only three patients (emotionally related) were transplanted in Saudi Arabia. Before transplantation, 50 (83.4 %) patients were on chronic hemodialysis, three (5 %) on peritoneal dialysis and three (5 %) were transplanted pre-emptively. Post-operatively, the majority of the study patients were on three drug immunosuppressive therapy. One and five year graft survival was 93.0 % and 59.6 %, while patient survival at one and three years was 93.7 % and 81 %, respectively. Surgical complications included lymphocele in 10 % of the study patients, urinary leak in 8.3 %, and bleeding from the vascular anastomosis in 6.6 %. There were eight episodes of acute rejection in eight (13.3 %) patients and all episodes were successfully treated ; two patients required monoclonal anti-lymphocyte antibodies (OKT3). Eleven (18.3 %) patients developed chronic rejection, which resulted in the loss of ten (90 %) allografts. Infection was the commonest cause for hospital admission ; urinary tract infection (UTI) being responsible for 40 % of admissions. Three patients had Cytomegalovirus pneumonia, one had Pneumocystis Carinii pneumonia and one had candida pneumonia. Two (3 %) patients developed Kaposi's sarcoma. We conclude that LURT can help in overcoming the shortage of organs for transplant, however, commercial transplantion in developing countries is associated with high morbidity and mortality.