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Pediatric kidney transplantation is the best option for treating children with end-stage renal disease. Poor economics, paucity of renal replacement therapy and transplantation facilities are the most important challenges of pediatric kidney transplantation in the Middle East.
The aim of the study was to collect data on the rates of pediatric kidney transplantation during a recent year from the Middle East countries. For that purpose, we have contacted all well-known kidney transplant centers from the Middle East to answer specified questions related to the volume of both adult and pediatric kidney transplantation from both living and deceased donors that was performed in each country during a recent year preferably 2021 or, in case data was not available, 2020 or 2019.
A total of 8772 kidney transplants have been performed for adults and pediatric patients in Middle East countries in one single recent year which makes the total kidney transplant rate per million populations per year 10.9 and ranged from 1.2 in Yemen & Pakistan to 39.7 in Turkey. Of this, 1399 transplants were from deceased donors which makes the percent of deceased donor kidney transplant 15.9% ranging from 0% in 10 countries to 64.2% in Iran. Out of these 8772 kidney transplants, 746 went for pediatric recipients (aged below 18 years), of this, 166 pediatric kidney transplants were from deceased donors which makes the percent of deceased donor pediatric kidney transplant 22.2% ranging from 0% in 11 countries to 100% in Tunisia. The average pediatric kidney transplant rate per million populations per year was 0.93 and ranged from <0.1 in Pakistan to 3.2 in Syria. The average pediatric kidney transplantation share was about 8.5% of the total kidney transplants and ranged from 3.2 in Iraq to 20% in Algeria. The deceased kidney transplant program is currently available only in 8 out of the 18 Middle Eastern countries included in this study. However, deceased program is active in some Middle East countries especially Iran, Turkey, Kingdome of Saudi Arabia, Kuwait, and United Arab Emirates. Of notes, Turkey had the highest kidney transplant rate per million populations per year (39.7); Syria had the highest pediatric kidney transplant rate per million populations per year (3.2); Iran had the highest deceased donor kidney transplant percent of the total kidney transplants (64.2%) and Iran alone has performed 63.5% (888/1399) of all deceased donor kidney transplants in the whole Middle East and 63.9% (106/166) of all deceased donor pediatric kidney transplants in the whole Middle East; and finally, Algeria had the highest pediatric kidney transplant share of the total transplants (20%).
Low health spending, poorly developed infrastructures, delayed referral of children with chronic kidney disease, com-morbidities, lacking technical expertise, inadequate pediatric dialysis programs, extended dialysis time, organ shortage, commercial transplantation, and post-transplant infections are the main pre and post-transplant challenges. The community-government partnership model from the Sindh Institute of Urology and Transplantation in Karachi Pakistan has shown that pediatric renal replacement therapy and transplantation can be successfully established in a developing country.
Although pediatric kidney transplantation is active in many parts of the Middle East, it is still inactive in others and mostly relying on living donors. The lacking deceased programs in most Middle East countries is a main issue to be addressed to adequately responding to the increasing demand for organs.