English abstract
Objectives: This study sought to report 22 years experience in pediatric kidney
transplantation in Oman. Methods: Electronic charts of all Omani children below
13 years of age who received a kidney transplant from January 1994 to December
2015 were reviewed. Data collected included patient demographics, etiology of end stage kidney disease, modality and duration of dialysis, donor type, complication of
kidney transplantation (including surgical complications, infections, graft rejection)
graft and patient survival, and duration of follow-up. Results: During the study period
transplantation from 27 living related donors (LRDs), 42 living unrelated donors
(LURDs), also referred to as commercial transplant, and one deceased donor were
performed. The median age at transplantation was nine years for both groups. The
most common primary diagnosis was congenital anomalies of the kidney and urinary
tract in 32.8% of patients followed by familial nephrotic syndrome in 20.0% and
polycystic kidney disease in 18.5%. Almost half the patients were on hemodialysis before
transplantation, 35.7% were on peritoneal dialysis, and 14.2% received preemptive renal
transplantation. Children who received LURD kidneys had high surgical complications
(42.8%) compared to the LRDs group (17.8%). Five patients from LURDs group had
early graft nephrectomy and four patients developed non-graft function or delayed
graft function. In addition, patients in the LURDs group had a higher incidence of
hypertension and acute rejection. Graft and patient survival were both better in the LRDs
than the LURDs group. Conclusions: Although our pediatric kidney transplant program
is a young program it has had successful patient outcomes comparable to international
programs. Our study provides evidence that in addition to legal and ethical issues with
commercial transplant, it also carries significantly higher morbidity and reduced graft
and patient survival.
