Spousal and living related kidney transplantation: our center experience

Background Kidney transplantation is the most preferred type of renal displacement therapy for end stage renal disease (ESRD) patients. More patients developed ESRD. The most important source is the donations from unrelated spouses. In this study, we aimed to compare the transplantation data obtained from the spouses of the patients with the transplantation data obtained from other relatives. Methods The data including 167 living kidney transplantations performed between January 2006 and December 2019 were retrospectively collected. The patients were divided into two groups; spousal donor group (n: 53) and living-related donor group (n: 114). Results There was no significant difference in delayed graft function in both groups. There were no patients with acute rejection proven by biopsy or considered biochemically in the spousal donor group. With regard to 3-year results in the living-related donor group the patient survival rate was 100%, while it was 98.2% in terms of graft survival. Conclusions In conclusion, similar patient and graft survival rates between spousal donor kidney transplantation and living-related kidney transplantation has made spousal donor kidney transplantation, with possible problems in terms of tissue compatibility, an acceptable alternative to donor supply.

Who is Coming to Japan Under The New Status of Residence “Specified Skilled Care Workers”?

The Japanese government created a new status of residence called “Specified Skilled Workers” encompassing 14 job categories that have laborer shortages, including long-term care (LTC) workers on April 1, 2019. A survey of students (N=79) at a language institute in Manila, Philippines was conducted in February, 2020 to explore characteristics of future foreign LTC workers in Japan under this new status of residence and identify factors that may help facilitate worker retention. At the time of data collected, these students were studying both Japanese and LTC practices in order to pass skill evaluation tests to enter Japan. Students were asked their perceptions of long-term care, planned lengths of stay, concerns about staying in Japan, and future career plans. Preliminary analyses revealed that 67 (88%) were single, 74(93.7%) had graduated from universities, and a half of them had a nursing background. Most students (93.7%) showed interest in an extended stay in Japan, with some interested in taking the national certified care worker examination which permits extended work in Japan. The most cited concern about being in Japan was “weather, climate and typhoons” (28.1%), followed by “language proficiency” and “living expenses” (21.9%) respectively. As Japan has limited immigration policies but a large need for LTC workers, it is imperative to understand how to attract and retain foreigners who obtain the Specified Skilled Worker status. This includes addressing both work-related and living-related concerns and needs.

Spousal and Living Related Kidney Transplantation: Our Center Experience

Background Kidney transplantation is the most preferred type of renal displacement therapy for ESRD patients. More patients developed end stage renal disease (ESRD). The most important source is the donations from unrelated spouses. In this study, we aimed to compare the transplantation data obtained from the spouses of the patients with the transplantation data obtained from other relatives. Methods The data including 167 living kidney transplantations performed between January 2006 and December 2019 were retrospectively collected. The patients were divided into two groups; spousal donor group (n: 53) and living-related donor group (n: 114). Results There was no significant difference in delayed graft function in both groups. There were no patients with acute rejection proven by biopsy or considered biochemically in the spousal donor group. With regard to 3-year results in the living-related donor group the patient survival rate was 100%, while it was 98.2% in terms of graft survival. Conclusions In conclusion, similar patient and graft survival rates between spousal donor kidney transplantation and living-related kidney transplantation has made spousal donor kidney transplantation, with possible problems in terms of tissue compatibility, an acceptable alternative to donor supply.

An Overview of Paediatric Liver Transplant in Hospital Selayang: 2002 to 2015

Introduction: Hospital Selayang started the liver transplant program in 2002. We report a total of 81 liver transplant cases until year 2015. Among these, paediatric cases constitute almost half. This report aims to review the demography and outcome of paediatric liver transplant cases. Methodology: Case notes of all paediatric patients underwent liver transplant from year 2002 to 2015 were retrospectively reviewed. Results: A total of 38 paediatric cases received liver transplantations from year 2002 to 2015. Age at transplantation ranged from 11 months to 16 years old (mean age 6 years) and weight ranged from 6.47 to 63 kilogram (mean 18kg). There were 20 males and 18 females, 20 of them were Malay, whereas Chinese and Indian were 13 and 4 respectively. Eighteen cases were living-related and 20 cases were cadaveric liver transplants. For recipient blood group, O+ is the commonest. Biliary atresia was the most common indication for liver transplant (22 cases; 58%), followed by intrahepatic cholestasis disorders (5 cases; 13%) and metabolic disease (4 cases; 10%). Post transplantation, there were 6 (16%) biliary complications, 12 (32%) vascular complications, 26 (68%) developed early onset infection, 13% had acute rejection and 2 graft failure. Out of the 38 transplants, 79% of them survive after 1 year, and 69.7% survive after 5 years. The common causes of mortality were sepsis and vascular complications. Conclusion: Despite limited resources, a successful paediatric liver transplant programme has been established in Hospital Selayang with good survival rate.

Renal Outcome and Health Related Quality of Life of Living Related Donors In Pediatric Kidney Transplantation

Objectives To assess the health related quality of life of living related donors after kidney transplantation and to evaluate clinical ,social and psychological condition post donation Study design This is an observational cross sectional study that included fifty living related donors of kidney transplant. All donors were assessed after at least one year of kidney donation. Data of the study was collected between April, 2019 and March, 2020. Methods The study included 50 living related donors;All donors were assessed after at least one year of kidney donation.WHOQOL-bref questionnaire (world health organization quality of life ) was used to assess quality of life of donors. Results The mean age at time of transplantation was 35.4±7.89 years. Eight cases developed hypertension after transplantation. There was no significant difference between serum creatinine before and after transplantation while there was significant decrease in glomerular filtration rate post transplantation. There was significant increase in fasting blood glucose and cholesterol in female donors compared to males.The results of the WHOQOL-bref questionnaire showed significant difference in results of psychological, social and environmental domains pre and post donation. Conclusion Proper selection of donors is very important to avoid complications post transplantation. Follow-up of donors should be maintained after donation.

Graft rejection after pediatric living related liver transplantation

Background: Rejection is an important adverse event after pediatric liver transplantation (LT). Aim: We aimed to study the incidence and risk factors for post-transplant rejection in pediatrics. Methods: The study included 40 pediatric patients underwent LT. All patients' records were reviewed. A wide range of potential risk factors for rejection, were recorded. Results: Rejection occurred in 13/40 (32.5%) of recipients. For the 13 rejecters, a total of 24 rejection attacks have occurred. 25% of which occurred during the 1st month post-LT. Acute rejection accounted for 54% of total rejection attacks, while chronic rejection occurred in 46%. LT for biliary atrasia (BA) was a significant risk factor for rejection. The means of transaminases levels were 268 ± 141 (IU/L) AST and 221 ± 119 (IU/L) ALT, biliary enzymes were 962 ± 687 (IU/L) for the ALKP and 485 ± 347 (IU/L) for the GGT, total BIL was 6.5 ± 7.1 (mg/dl), and FKL levels were 10.4 ± 5.6 (ng/ml) during the rejection attacks. Chronic rejection contributed to death of only one of the cases. Conclusion: BA was a significant risk for rejection. Elevated transaminases and biliary enzymes but not FK trough level is alarming signs for presence of rejection. Keywords: liver transplantation; pediatrics; rejection.