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

Diabetes complications in 1952 type 2 diabetes mellitus patients managed in a single institution

Background and Objectives: Because there is no recent update on the state of diabetes and its concomi--tant complications in Saudi Arabia , we undertook a study of the prevalence of health complications in patients with type 2 diabetes mellitus admitted to our institution. Methods: We conducted a retrospective review of medical records of adult Saudi patients with type 2 diabetes who were seen in clinics or admitted to the Security Forces Hospital , Riyadh , Saudi Arabia , between January 1989 and January 2004. Results: Of 1952 patients , 943 (48.3%) were males. For the whole study population the mean age at enrollment was 58.4±14.2 years , the mean age at onset of diabetes was 48.1±12.8 years , the mean duration of diabetes was 10.4±7.5 years , and the mean duration of follow-up was 7.9±4.6 years. Nephropathy was the most prevalent complication , occurring in 626 patients (32.1%). Acute coronary syndrome occurred in 451 (23 .1 %), cataracts in 447 (22.9%) , retinopathy in 326 (16.7%) , and myocardial infarction in 279 (14.3%) , Doubling of serum creatinine was seen in 250 (12.8%) and 79 (4.0%) went into dialysis. Hypertension was present in 1524 (78.1%) and dyslipidemia in 764 (39.1%). Overall mortality was 8.2%. Multiple complications were frequent. Males had higher prevalence of complications than females (P< .05). Mortality was significantly higher in males 92 (9.8%) than females 69 (6.8%) (P=.024). The prevalence of complications significantly increased with dura--tion of diabetes and age (P< .05). Conclusion: Among Saudis, the prevalence of concomitant diabetic complications is high, with cardiovas--cular and renal complications the most frequent. Many patients had multiple complications. Early and frequent screenings in the patients with type 2 diabetes are desirable to identify patients at high risk for concomitant complications and to prevent disabilities