Summary Background Chronic kidney disease is an important cause of global mortality and morbidity. Data for epidemiological features of chronic kidney disease and its risk factors are limited for ...low-income and middle-income countries. The International Society of Nephrology's Kidney Disease Data Center (ISN-KDDC) aimed to assess the prevalence and awareness of chronic kidney disease and its risk factors, and to investigate the risk of cardiovascular disease, in countries of low and middle income. Methods We did a cross-sectional study in 12 countries from six world regions: Bangladesh, Bolivia, Bosnia and Herzegovina, China, Egypt, Georgia, India, Iran, Moldova, Mongolia, Nepal, and Nigeria. We analysed data from screening programmes in these countries, matching eight general and four high-risk population cohorts collected in the ISN-KDDC database. High-risk cohorts were individuals at risk of or with a diagnosis of either chronic kidney disease, hypertension, diabetes, or cardiovascular disease. Participants completed a self-report questionnaire, had their blood pressure measured, and blood and urine samples taken. We defined chronic kidney disease according to modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria; risk of cardiovascular disease development was estimated with the Framingham risk score. Findings 75 058 individuals were included in the study. The prevalence of chronic kidney disease was 14·3% (95% CI 14·0–14·5) in general populations and 36·1% (34·7–37·6) in high-risk populations. Overall awareness of chronic kidney disease was low, with 409 (6%) of 6631 individuals in general populations and 150 (10%) of 1524 participants from high-risk populations aware they had chronic kidney disease. Moreover, in the general population, 5600 (44%) of 12 751 individuals with hypertension did not know they had the disorder, and 973 (31%) of 3130 people with diabetes were unaware they had that disease. The number of participants at high risk of cardiovascular disease, according to the Framingham risk score, was underestimated compared with KDIGO guidelines. For example, all individuals with chronic kidney disease should be considered at high risk of cardiovascular disease, but the Framingham risk score detects only 23% in the general population, and only 38% in high-risk cohorts. Interpretation Prevalence of chronic kidney disease was high in general and high-risk populations from countries of low and middle income. Moreover, awareness of chronic kidney disease and other non-communicable diseases was low, and a substantial number of individuals who knew they were ill did not receive treatment. Prospective programmes with repeat testing are needed to confirm the diagnosis of chronic kidney disease and its risk factors. Furthermore, in general, health-care workforces in countries of low and middle income need strengthening. Funding International Society of Nephrology.
Summary
Donation after circulatory death (DCD) has become an accepted practice in many countries and remains a focus of intense interest in the transplant community. The present study is aimed at ...providing a description of the current situation of DCD in European countries. Specific questionnaires were developed to compile information on DCD practices, activities and post‐transplant outcomes. Thirty‐five countries completed the survey. DCD is practiced in 18 countries: eight have both controlled DCD (cDCD) and uncontrolled DCD (uDCD) programs, 4 only cDCD and 6 only uDCD. All these countries have legally binding and/or nonbinding texts to regulate the practice of DCD. The no‐touch period ranges from 5 to 30 min. There are variations in ante and post mortem interventions used for the practice of cDCD. During 2008–2016, the highest DCD activity was described in the United Kingdom, Spain, Russia, the Netherlands, Belgium and France. Data on post‐transplant outcomes of patients who receive DCD donor kidneys show better results with grafts obtained from cDCD versus uDCD donors. In conclusion, DCD is becoming increasingly accepted and performed in Europe, importantly contributing to the number of organs available and providing acceptable post‐transplantation outcomes.
Background: Numerous studies focusing on public attitude towards organ donation have been performed at the international level, but very few highlight public attitude towards tissue and cell donation ...and transplantation. Material and methods: We conducted a survey among a representative sample of the general adult population (N=427). The questionnaire was developed on the basis of previous study and included reuse of some items from the earlier survey to facilitate historical comparison. The analysis of the data was carried out using SPSS, 2011 and focused on descriptive statistics. Results: The vast majority of our respondents (81.0%) agreed with the tissue and cell donation and only every 10th respondent did not accept this. The fewer respondents (68.1%) would agree to have tissues and cells transplanted from other people compared to those who were willing to donate tissues and cells (81.0%). Finally, most of the respondents (85.0%) expressed interest in receiving more information, and were very similar to those in receiving more information on organ donation and transplantation (88.0%) Conclusions: The study revealed the respondents’ positive attitude towards tissue and cell donation and transplantation and demonstrated a remarkable growth in the public positive attitude towards donation. Furthermore, as the vast majority of our respondents wanted to receive more information on these issues, it seems to be a clear opportunity to develop educational and promotional strategies to improve awareness and enhance donation rates in our country.
In high-risk kidney transplant recipients, induction therapy with rabbit anti-human thymocyte globulin (RATG) reduces the risk for acute rejection but is associated with significant toxicity, ...opportunistic infections, and cancer. Using reduced doses of RATG combined with anti-IL-2 antibodies may achieve the same antirejection activity of standard-dose RATG but with a better safety profile. This randomized, open-label study compared the efficacy, tolerability, and costs of low-dose RATG (0.5 mg/kg per d) plus basiliximab (20 mg 4 d apart) versus standard-dose RATG (2 mg/kg per d) in 33 consecutive high-risk renal transplant recipients (living-related transplant recipients, sensitized patients or patients who received another transplant, and patients with delayed graft function) over 6 mo of follow-up. All patients received concomitant therapy with steroids, cyclosporin A, and azathioprine or mycophenolate mofetil. Seventeen patients received low-dose RATG plus basiliximab, and 16 received standard-dose RATG. Patient (100 versus 100%) and graft (94 versus 100%) survival were comparable in the two groups, but the incidence of fever (17.6 versus 56.5%; P = 0.01), leukopenia (23.5 versus 56.3%; P < 0.05), anemia (29.4 versus 62.5%; P < 0.05), cytomegalovirus reactivations (17.6 versus 56.5%; P = 0.01), the number of transfused units (0.5 +/- 0.9 versus 2.0 +/- 2.4; P < 0.001), and treatment costs (3652 +/- 704 versus 5400 +/- 1960 euro; P = 0.001) were lower with low-dose RATG plus basiliximab than with standard-dose RATG. There was one episode of biopsy-proven acute rejection on low-dose RATG plus basiliximab, and there were two on standard-dose RATG. In renal transplantation, induction therapy with basiliximab plus low-dose RATG effectively prevents acute rejection and is safer and more cost-effective than induction with standard-dose RATG.
Abstract
Background and Aims
During the last decade, the development of kidney transplantation in the Republic of Moldova took a new course due to the adoption of the new transplantation law, and was ...strongly marked by the first transplant from a brain death donor. The implementation of a transparent organ allocation policy, the development of donation after brain death and the upgrade of the transplant infrastructure, based on European good practices, are the strengths of the new program.
Method
Since 2014, all the kidney grafts from deceased donors have been allocated based on the electronic allocation system (Renal Score), which includes the following variables: compatibility in ABO and HLA systems, dialysis vintage, time on waiting list, renal graft accessibility score, age difference between recipient and donor. All the living donors were evaluated based on a National Protocol. This is a retrospective analysis of the kidney transplant program during a period of five years, focused on recipient and donor demographics, donor-recipient matching, medical outcomes.
Results
During 2014-2018, there were performed 75 kidney transplantations: 23 (30,7%) from living donors and 52 (69,3 %) from brain-death donors. Among the kidney transplant recipients, there were 24 women (32,4%) and 50 men (67.6%). From 23 living kidney donors there were 10 (43,5%) males and 13 (56,5%) females, 21 (91,3%) were related donors and 2 (8,7%) emotionally related. The mean age of living donors was 50,45, ranging from 23 to 67, with 6 donors (20,1%) older than 60 years old.
During this period, from 110 evaluated potential brain death donors 48 (43,6%) became effective brain-death donors and kidneys were procured in 36 (75%) cases (from 15 men (41,7%) and 21 women (58,3%)). The mean recipients age was 41,13, ranging from 23 to 67, while the mean donor age was 54,72, ranging from 19 to 72 years old. 18 donors (50%) were older than 60, the mean age of male donors were 49,4 and 59,14 for female donors. The mean donor-recipient age difference was 17,09 years (min- 0, max- 40). The mean cold ischemia time was 17,31 hours, with a minimum of 6,33 hours and a maximum of 25,8 hours. The majority of donors were blood type 0- 14 (38.8%) and A-13 (36,1%) and only 6 donors (16.6%) blood type B and 3 (8.3%) type AB. Regarding the outcomes, we noticed a rate of delayed graft function in 43,6% cases, 2,6% of slow graft function and 53,9% recipients with immediate graft function
Conclusion
Despite social and economic challenges in our country, the joint efforts of the kidney transplant team, the Transplant Agency and the government support ensure a growing kidney transplant program. The strengths of our program are the good legal framework and the respect for the main ethical and medical principals: transparency and traceability, ensured by the informational platform, equity and utility ensured by the use of the automated allocation system, accessibility ensured by the fool coverage of transplant related services by the public health insurance. We still face many challenges, as the high rate of marginal donors compared to younger recipients and donor-recipient age disparities, a long cold ischemia time and a sub-optimal organ discard rate, which is mainly due to the shortage of transplant professionals, the direct effect of the migration of health care personnel. Our next goal is to identify and to improve the factors impacting on kidney graft outcomes in order to achieve better results.
In 2005, the International Society of Nephrology (ISN) established the Global Outreach Program (GO) aimed at building a capacity for detecting and managing chronic kidney disease and its ...complications in low- and middle-income countries. Here we report data from the 2006-2007 screening program (1025 subjects from the general population) in the Republic of Moldova aimed to determine the prevalence of hypertension, diabetes, and their coexistence with microalbuminuria. The likelihood of a serious cardiovascular (CV) event was also estimated. Hypertension and diabetes were very common among screened subjects. The prevalence of microalbuminuria was 16.9% and that of estimated GFR <60 ml/min/1.73 m2 (decreased renal function) was 9.4%. Male gender was associated with an increased prevalence of hypertension and microalbuminuria. Hypertension and diabetes clustered in subjects with microalbuminuria and renal dysfunction. Risk factors such as preobesity/obesity, physical inactivity and smoking were relatively common, even in younger participants. The prevalence of subjects with predicted 10-year CV risk ≥10% was 10.0%. In conclusion, in the Republic of Moldova patients with hypertension and diabetes should be screened for the coexistence of renal abnormalities, with the intention of developing disease-specific health-care interventions with the primary goal to reduce CV morbidity and mortality and prevent renal disease progression to end stage renal disease.
Many nations are able to prosecute transplant-related crimes committed in their territory, but transplant recipients, organ sellers and brokers, and transplant professionals may escape prosecution by ...engaging in these practices in foreign locations where they judge the risk of criminal investigation and prosecution to be remote.
The Declaration of Istanbul Custodian Group convened an international working group to evaluate the possible role of extraterritorial jurisdiction in strengthening the enforcement of existing laws governing transplant-related crimes across national boundaries. Potential practical and ethical concerns about the use of extraterritorial jurisdiction were examined, and possible responses were explored.
Extraterritorial jurisdiction is a legitimate tool to combat transplant-related crimes. Further, development of a global registry of transnational transplant activities in conjunction with a standardized international referral system for legitimate travel for transplantation is proposed as a mechanism to support enforcement of national and international legal tools.
States are encouraged to include provisions on extraterritorial jurisdiction in their laws on transplant-related crimes and to collaborate with professionals and international authorities in the development of a global registry of transnational transplant activities. These actions would assist in the identification and evaluation of illicit activities and provide information that would help in developing strategies to deter and prevent them.
The Declaration of Istanbul on Organ Trafficking and Transplant Tourism Participants in the International Summit on Transplant Tourism and Organ Trafficking Convened by The Transplantation Society and International Society of Nephrology in Istanbul, Turkey, April 30 through May 2, 2008
Clinical journal of the American Society of Nephrology,
09/2008, Letnik:
3, Številka:
5
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
Organ commercialism, which targets vulnerable populations (such as illiterate and impoverished persons, undocumented immigrants, prisoners, and political or economic refugees) in resource-poor ...countries, has been condemned by international bodies such as the World Health Organization for decades. Yet in recent years, as a consequence of the increasing ease of Internet communication and the willingness of patients in rich countries to travel and purchase organs, organ trafficking and transplant tourism have grown into global problems. For example, as of 2006, foreigners received two-thirds of the 2000 kidney transplants performed annually in Pakistan. The Istanbul Declaration proclaims that the poor who sell their organs are being exploited, whether by richer people within their own countries or by transplant tourists from abroad. Moreover, transplant tourists risk physical harm by unregulated and illegal transplantation. Participants in the Istanbul Summit concluded that transplant commercialism, which targets the vulnerable, transplant tourism, and organ trafficking should be prohibited. And they also urged their fellow transplant professionals, individually and through their organizations, to put an end to these unethical activities and foster safe, accountable practices that meet the needs of transplant recipients while protecting donors. Countries from which transplant tourists originate, as well as those to which they travel to obtain transplants, are just beginning to address their respective responsibilities to protect their people from exploitation and to develop national self-sufficiency in organ donation. The Declaration should reinforce the resolve of governments and international organizations to develop laws and guidelines to bring an end to wrongful practices. "The legacy of transplantation is threatened by organ trafficking and transplant tourism. The Declaration of Istanbul aims to combat these activities and to preserve the nobility of organ donation. The success of transplantation as a life-saving treatment does not require-nor justify-victimizing the world's poor as the source of organs for the rich" (Steering Committee of the Istanbul Summit).
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