Pediatric Nephrology

, 25:155 | Cite as

Outcomes of kidney transplant tourism in children: a single center experience

  • Abdul Majid
  • Lina Al Khalidi
  • Bushra Q. Ahmed
  • Gerhard Opelz
  • Franz Schaefer
Original Article

Abstract

Transplant tourism is a necessity for children with end-stage renal disease living in regions without established local transplantation programs. The use of kidneys from living unrelated donors (LURDs) was common practice in Asia prior to the recent global condemnation of commercial organ transplantation. Objective information on the outcomes of pediatric transplant tourism is scarce. Here, we report the Dubai experience with 45 renal allograft transplantations performed outside the United Arab Emirates (UAE) between 1993 and 2009. Transplantation from 33 LURDs, ten living related donors (LRDs) and two deceased donors was performed in 14 different countries. The mean number of human leukocyte antigen (HLA) A/B/DR allele matches was 1.4 ± 0.8 in the LURD graft recipients and 3.9 ± 0.7 in the LRD recipients. Outcomes were compared with those of a matched group of 3,150 pediatric LRD transplantations from the Collaborative Transplant Study (CTS). Ten-year patient survival was 100% in the LRD patients, 91.2% in the LURD patients, and 92% in the CTS patients. The three deaths in the LURD group occurred within the first 4 months after transplantation and were related to acute rejection. One-year and 10-year graft survival was 100% in the LRD group and 94.8% and 66.7% in the CTS-LRD groups, vs 87.8% and 43.4% in the LURD group. Major viral infections [Epstein–Barr virus (EBV), cytomegalovirus (CMV), varicella zoster (VZV)] were four-times more common in patients that had received LURD grafts than in those that had received LRD grafts. In conclusion, whereas LRD kidney transplantation performed abroad yields excellent long-term results, transplantation of LURD kidneys is fraught with a high complication rate affecting graft and even early patient survival.

Keywords

Commercial organ transplantation Living related Living unrelated Pediatric kidney transplantation Developing world Living unrelated donation Transplant tourism Developing countries Global pediatric nephrology 

References

  1. 1.
    Steering committee of the Istanbul Summit (2008) Organ trafficking and transplant tourism and commercialism: the Declaration of Istanbul. Lancet 372:5–6CrossRefGoogle Scholar
  2. 2.
    Salahudeen AK, Woods HF, Pingle A, Nur-El-Huda Suleyman M, Shakuntala K, Nandakumar M, Yaha TM, Daar AS (1990) High mortality among recipients of bought living-unrelated donor kidneys. Lancet 336:725–728CrossRefPubMedGoogle Scholar
  3. 3.
    Ivanovski N, Stojkovski L, Cakalaroski K, Masin G, Djikova S, Polenakovic M (1997) Renal transplantation from paid, unrelated donors in India: it is not only unethical, it is also medically unsafe. Nephrol Dial Transplant 12:2028–2029CrossRefPubMedGoogle Scholar
  4. 4.
    Sever MS, Kazancioğlu R, Yildiz A, Türkmen A, Ecder T, Kayacan SM, Celik V, Sahin S, Aydin AE, Eldegez U, Ark E (2001) Outcome of living unrelated (commercial) renal transplantation. Kidney Int 60:1477–1483CrossRefPubMedGoogle Scholar
  5. 5.
    Kennedy SE, Shen Y, Charlesworth JA, Mackie JD, Mahony JD, Kelly JJ, Pussell BA (2005) Outcome of overseas commercial kidney transplantation: an Australian perspective. Med J Aust 182:224–227PubMedGoogle Scholar
  6. 6.
    Prasad GV, Shukla A, Huang M, D’A Honey RJ, Zaltzman JS (2006) Outcomes of commercial renal transplantation: a Canadian experience. Transplantation 82:1130–1135CrossRefPubMedGoogle Scholar
  7. 7.
    Canales MT, Kasiske BL, Rosenberg ME (2006) Transplant tourism: outcomes of United States residents who undergo kidney transplantation overseas. Transplantation 82:1658–1661CrossRefPubMedGoogle Scholar
  8. 8.
    Gill J, Madhira BR, Gjertson D, Lipshutz G, Cecka JM, Pham PT, Wilkinson A, Bunnapradist S, Danovitch GM (2008) Transplant tourism in the United States: a single-center experience. Clin J Am Soc Nephrol 3:1820–1828CrossRefPubMedGoogle Scholar
  9. 9.
    Collaborative Transplant Study, University of Heidelberg, Germany. Available at: www.ctstransplant.org.
  10. 10.
    North American Pediatric Renal Trials and Collaborative Studies (2009) NAPRTCS 2008 Annual report. Published online at http://spitfire.emmes.com/study/ped/annlrept/Annual%20Report%20-2008.pdf
  11. 11.
    Su X, Zenios SA, Chakkera H, Milford EL, Chertow GM (2004) Diminishing significance of HLA matching in kidney transplantation. Am J Transplant 4:1501–1508CrossRefPubMedGoogle Scholar
  12. 12.
    Agarwal S, Oak N, Siddique J, Harland RC, Abbo ED (2009) Changes in pediatric renal transplantation after implementation of the revised deceased donor kidney allocation policy. Am J Transplant 29:1237–1242CrossRefGoogle Scholar
  13. 13.
    Said MR, Curtis JJ (1998) Living unrelated transplantation: progress and potential. J Am Soc Nephrol 9:2148–2152PubMedGoogle Scholar
  14. 14.
    Terasaki PI, Cecka JM, Gjertson DW, Takemoto S (1995) High survival rates of kidney transplants from spousal and living unrelated donors. N Engl J Med 333:333–336CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2009 2009

Authors and Affiliations

  • Abdul Majid
    • 1
  • Lina Al Khalidi
    • 1
  • Bushra Q. Ahmed
    • 1
  • Gerhard Opelz
    • 2
  • Franz Schaefer
    • 3
  1. 1.Division of Pediatric NephrologyDubai HospitalDubaiUnited Arab Emirates
  2. 2.Division of Transplantation ImmunologyHeidelberg UniversityHeidelbergGermany
  3. 3.Division of Pediatric NephrologyCenter for Pediatrics and Adolescent MedicineHeidelbergGermany

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