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Commercial kidney transplantation is still actively attracting a significant proportion of patients with grave consequences. This is because standards of patient care are not being followed in most cases with sub-optimal transplant settings. We aimed to assess the complications and outcomes of the commercial transplants undergoing follow-up at our center and their impact on the healthcare system.
We conducted a retrospective review of adult Kidney transplant recipients (KTRs) who were transplanted commercially overseas from unrelated donors in the period from Jan 2020 to September 2023 and then presented to our Center for post-transplant care and follow-up.
Fifty-eight KTRs were identified, 40 men (69 %) and 18 women (31%). The median age at transplantation was 36 years (Interquartile range (IQR) 30-45). All patients received their kidneys in Pakistan and presented on a median of day 5 (IQR 3-5) post-transplant. This was the first kidney graft for 45 (77.6 %) patients and the second for 13 (22.4%). Upon presentation, 35/58 (60.3%) indicated hospitalization for a median of 10 days (IQR 5-30 days), and 13 (22.4%) suffered delayed graft function. Patients were then followed up for a median of 14.5 months (IQR 7-17 months). Median creatinine at presentation was 161.5 mmol/l (IQR 117.25 – 440.5), which improved to 105 (89.75-125.5) by the end of 1st year and stabilized at 107 (86-126.75) mmol/l at the end of follow up (graph). 78.9% of the patients had at least one hospital admission over the 1st post transplant year with median length of hospital stay (LoS) of 23.5 days (IQR 7-32.5).
Over the follow-up period, a total of 48 rejection episodes occurred in 33 KTRs (56.9%), 27 of them occurred in 25 patients within the 1st post-transplant month. Urinary tract infection (UTI) was the most frequent Infectious complication affecting 22/58 patients of whom 14 had recurrent UTI in addition to 4 patients having epididymo-Orchitis. Surgical site infection affected 8 patients. Newly acquired HCV infection was detected in 2 and HIV in one, while CMV viremia was detected in 15 KTRs. Malarial infection with plasmodium falciparum was encountered in 2 patients and Fungal infection in 7 (candida in 5 and aspergillosis in 2). Urologic complications affected 37/58 patients with ureteric stenosis encountered in 10 and urinary leak in 7 patients. This indicated nephrostomy in 13 for urine leak and/or hydronephrosis and perinephric fluid drainage in 8 KTRs.
The mortality rate was 5.17% (3/58), and the death-censored graft loss was 4/58 (6.9%) all had graft nephrectomy.
Graph: Boxplot depicting creatinine levels (mmol/l) at different time points throughout the follow-up period.
Commercial kidney transplantation remains a significant health and ethical challenge. It entails high rates of DGF, rejections, infections, and urologic complications. This leads to a complicated post-transplant course with relatively long LoS and high rates of interventions, mortality, and graft loss. As such, it is imperative that all efforts be exerted to combat commercial transplant practices.