Prof. Mehmet Haberal, President, Middle Eastern Society of Transplantation addressing the 6th International Symposium of Urology, Nephrology and Transplantation of SIUT recently in Karachi said that Baskent University has performed 233 liver transplants till date and 48 percent of them were performed on children. The first of which was performed in 1990 on a 10-month-old child.
He said that the number of organs donated is much less than the number of organs available as brain dead organ donation is still not popular and only organ donations from close relatives are accepted.
The University has decided to work on education in all fields and is now working on making two primary and high schools.
Foreign speakers include Dr. Sarwat Hussain from New York; Dr. M. A. Salam from Dhaka; Dr. L.B. Zimmerhackl from Austria; Prof. K.S. Chugh, from India; Dr. Bassam Saeed from Syria; Dr. Reusz from Hungary; Dr. Hugh Whitfield from UK; Dr. Sayegh from USA; Dr. Mani from India, Dr. Masri from Lebanon; Dr. Tauqir Rana, from Riyadh, along with Dr. Shabbir Naeem, of SIUT address the symposium.
Dr. M. A Salam from Dhaka spoke on the treatment of a narrowed urethra by taking a graft from the mucous membrane of the mouth. Narrowing of the urethra can take place due to injury, infection and catheterisation. This procedure gave an overall success rate of 91%.
Dr. L.B Zimmerhackl from Austria delivered a talk on treatment of renal failure secondary to glomerulosclerosis in kidney transplantation cases. Improved immunosuppression has significantly decreased the reoccurrence rate. He discussed the new strategies, which included treatment with CD20 antibody.
Prof. K.S. Chugh, Nephrologist, India talked on community acquired acute renal failure in developing countries, which is more common than in Europe or North America. The causative factors include malaria, diarrhoeal diseases, leptosespirosis, copper sulphate poisoning, snake bites, insect stings, industrial poisoning, heat stroke and complications of pregnancy. Patients often present late and due to lack of methods of renal replacement therapy, the mortality rate is high.
Dr. Bassam Saeed from Syria spoke on obstruction of the kidneys leading to failure. He gave the results of 330 children with chronic kidney disease followed up in his centre. Of these 101 were due to obstructive causes, two-thirds were male and 9% had a similar family history. 35 patients were on dialysis and only one had received a kidney transplant. The high prevalence of obstructed kidney disease is due to lack of preventive and treatment facilities. Cousin marriages are also an important cause.
Dr. Reusz from Budapest, Hungary spoke on arterial stiffness being a cause of cardiovascular mortality. This process is accelerated by kidney failure and reversed by transplantation. Similar is the case in children where they also encounter growth retardation. He suggested that the cardiovascular changes secondary to kidney failure are reversed by transplantation.
The second day of the Symposium was a session day on “Diabetic kidney disease”. Prof K.S.Chugh India talked on diabetic nephropathy to be the commonest cause of renal failure. Early diagnosis leads to lack of prevention. Screening for diabetic kidney disease includes evaluation of albumin in the urine, presence of diabetic eye changes and type 1 diabetes of 10 years duration.
Dr. Fatema Jawad of SIUT described the scenario of diabetes and kidney disease in the Institute. To date 84 (74 males and 10 females) diabetics have been transplanted. Patients for transplant surgery are evaluated in detail and eventually as they achieve the required criteria they receive a kidney from a matched relative. The patient and graft survival at 1 & 5 years in the institute matches the international results.
Dr. Magdi Shehata from Nottingham University UK spoke on injury to transplanted kidney due to toxicity of immunosuppressive drug calcineurin inhibitor. Studies have shown that the graft function and survival can be maintained safely without these drugs.
Dr. Zac Varghese from Royal Free medical school, London described relationship of Sirolimus, a potent immunosuppressive agent, and the development of raised lipid levels. Analysis confirmed that Sirolimus reduced cholesterol accumulation.
Dr. Georgi Abraham from Chennai, India talked on the challenges of renal replacement therapy in Asia. He said that over 90% of patients with ESRD in south-Asian countries die within few months of diagnosis because of unaffordability. He said that hemodialysis is the most common cause of renal replacement therapy in Asia.
Prof. Qasim Mehdi, Director Centre for human genetics and molecular medicine, SIUT, described genetic history of modern humans which has been placed back to approximately 200,000 years. He said the migrants from Africa to other parts of the world faced challenges to climate and diseases. Those who were genetically strong survived. He talked on the diversity of the highly polymorphic human leukocyte antigen which is important for matching organs in the field of transplantation.
Prof. Sajjad Hussain of the Pakistan Association of Urological Surgeons talked on the development of lithotripsy for kidney stone management. He said it was a new technology introduced in the 21st century which has reduced the incidence of open surgery. Flexible endoscopes are used for managing open urinary tract stones. Medical treatment is important as alpha-adrenergic blockers increase the speed of passage of ureteric stones.
Dr. Michael Bos from USA discussed the concept of brain death which was introduced in 1960s. This involves medical and ethical issues along with cultural, legal and religious factors which determine the procurement of an organ after brain death is publicly accepted.
The third day of the 6th International Symposium of Urology, Nephrology & Transplantation of SIUT, began with a deliberation on the use of generic drugs by Dr. Marwan Masri from Lebanon. He said generic immunosuppressive drugs have reduced the cost of treatment and are as effective as the patented ones. The Federal Drug Agency has approved their use if they are checked regularly to have the required active ingredient.
Dr. Michael Bos of Amsterdam, presents his views on new approaches in living kidney donation. There is better survival and outcome of a kidney from a living donor. Transplantation before the kidney completely shuts down; gives even better results.
Dr. Jha, nephrologist from Chandigarh, India Spoke on ethics of paid kidney donation. He said that equal rights are not practiced in our culture. If an organ is sold the amount received by the vendor does not last long. It does not help him to come out of poverty. There are examples of cheating the vendor. After removal of the kidney no one takes the responsibility of the vendor related to medical requirements self esteem and finances. It also shows that there is no system for the poor people. In India the government has a budget of less than 1% of the GDP. The private sector contributes 4.7%. Medical treatment is expensive and not affordable by the masses.
Dr. Oswald Fernando from UK spoke on the challenges of transplantation. As the deceased donor organ donation programme is prevalent in many countries of the world, questions asked are that “Who owns the body- family or state? His question can be answered in an ethical manner by developing awareness and donor cards signed by all.
Transplantation in children faces challenges also. Non-compliance with drugs, growth retardation, cosmetic effects and a compromised quality of life can also influence the outcome.
Dr. Padilla, President of the Philippines Association of Nephrologists talked on challenges on organ donation in her country. She said that the incidence of kidney failure is rising. Most of the transplants performed are living related. In 2008 a president’s directive declared kidney transplant in foreigners from phillipino living donors to be illegal. This is working as yet. In 2007 foreign patients transplanted were 528.Out of these 75% were from middle east where as 484 were local. Each donor received US$ 3270. Implementing rules and regulations will help to improve the deceased donor programme.
Dr. Luc Noel, WHO representative from Geneva delivered the world report on transplantation. He said that guidelines have been prepared to maximize deceased organ donation by following strict criteria for brain death, prohibition of financial profits by sale of human body parts. He said the long term follow up recipients including adverse events to maximize safety of donation and transplantation. This is only possible if the whole procedure is transparent. Dr Luc Noel said that success lies in motivation by observing the well being of the organ recipients which is shown as a reality by the media and the coordinating authority.