Health Status and Renal Function Evaluation of Kidney Vendors: A Report from Pakistan

Unrelated kidney transplants have lead to commerce and kidney vending in Pakistan. This study on 104 vendors reports demographics, history, physical and systemic examination, ultrasound findings, renal and liver function and GFR by Cockcroft-Gault. Results were compared with 184 age, sex and nephrectomy duration matched living-related donors controls. Comparison of vendors versus controls showed mean age of 30.55 +/- 8.1 versus 30.65 +/- 7.85 (p = 0.91) years, M:F of 4.5:1 versus 4.2:1 and nephrectomy period of 33.89 +/- 30 versus 32.01 +/- 29.71 (p = 0.60) months respectively. Of the vendors 67% were bonded laborers earning 100 $/month. History of vendors revealed jaundice in 8%, stone disease in 2% and urinary tract symptoms in 4.8%. Postnephrectomy findings between vendors versus donors showed BMI of 21.02 +/- 2.8 versus 23.02 +/- 4.2 (p = 0.0001), hypertension in 17% versus 9.2% (p = 0.04), serum creatinine (mg/dL) of 1.17+/-0.21 versus 1.02 +/- 0.27 (p = 0.0001), GFR (mL/min) of 70.94 +/- 14.2 versus 95.4 +/- 20.44 (p = 0.0001), urine protein/creatinine of 0.150 +/- 0.109 versus 0.10 +/- 0.10 (p = 0.0001), hepatitis C positivity in 27% versus 1.0% (p = 0.0001) and hepatitis B positive 5.7% versus 0.5% (p = 0.04), respectively. In conclusion, vendors had compromised renal function suggesting inferior selection and high risk for developing chronic kidney disease in long term. Copyright (C) 2008 Blackwell Publishing Ltd.; References: 1. Evans RW, Kitzmann DJ. An economic analysis of kidney transplantation. Surg Clin North Am 1998; 78: 149-74. 2. Dew MA, Switzer GE, Goycoolea JM et al. Does transplantation produce quality of life benefits? A quantitative analysis of the literature. Transplantation 1997; 64: 1261-1273. 3. Sakhuja V, Kohli HS. End-stage renal disease in India and Pakistan: Incidence, causes, and management. Ethn Dis 2006; 16(2 Suppl 2): S2-20-3. 4. Rizvi SAH, Naqvi SAA, Zafar MN. Renal transplantation in Pakistan. In: Cecka MJ, Terasaki PI (eds.) Clinical Transplants. Los Angels: UCLA Immonogenetics Center, 2002:191-200. 5. Bertram L, Kasiske BL, Bia MJ. The evaluation and selection of living kidney donors. Am J Kidney Dis 1995; 26: 387-398. 6. Naqvi SA, Mazhar F, Ahmed R, Jamal H, Zaidi R, Rizvi A. Limitation in selection of donors in a living-related renal transplant programme. Transplant Proc 1998; 30: 2286-2288. 7. Ramcharan T, Matas AJ. Long-term (20-37 years) follow-up of living kidney donors. Am J Transplant 2002; 2: 959-964. 8. Sahay M, Narayen G, Anuradha. Risk of live kidney donation-Indian perspective. J Assoc Physicians India 2007; 55: 267-270. 9. Fehrman-Ekholm I, Duner F, Brink B, Tyden G, Elinder CG. No evidence of accelerated loss of kidney function in living kidney donors: Results from a cross-sectional follow-up. Transplantation 2001; 72: 444-449. 10. Gossmann J, Wilhelm A, Kachel HG et al. Long-term consequences of live kidney donation follow-up in 93% of living kidney donors in a single transplant center. Am J Transplant 2005; 5: 2417-2424. 11. Boudville N, Prasad GV, Knoll G et al. Donor Nephrectomy Outcomes Research (DONOR) Network. Meta-analysis: Risk for hypertension in living kidney donors. Ann Intern Med 2006; 145: 185-196. 12. Garg AX, Muirhead N, Knoll G et al. Donor Nephrectomy Outcomes Research (DONOR) Network. Proteinuria and reduced kidney function in living kidney donors: A systematic review, meta-analysis, and meta-regression. Kidney Int 2006; 70: 1801-1810. 13. Rizvi SA, Naqvi SA, Jawad F et al. Living kidney donor follow-up in a dedicated clinic. Transplantation 2005; 79: 1247-1251. 14. Quick Kidney Quips. Available at: http://www.kidney.sk.ca/services/newsletters/QKQ/documents/2007/April%20... (accessed on October 18, 2007). 15. Naqvi SA, Ali B, Mazhar F, Zafar MN, Rizvi SA. A socioeconomic survey of kidney venders in Pakistan. Transpl Int 2007; 20: 934-939. Epub 2007 Jul 20. 16. Goyal M, Mehta RL, Schneiderman LJ, Sehgal AR. Economic and health consequences of selling a kidney in India. JAMA 2002; 288: 1589-1593. 17. Zargooshi J. Quality of life of Iranian kidney "donors". J Urol 2001; 166: 1790-1799. 18. Ginsberg JM, Chang BS, Matarese RA, Garella S. Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med 1983; 309: 1543-1546. 19. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31-41. 20. Haberal M. Living donor kidney transplantation: How far should we go? Urol J 2004; 1: 148-156. 21. Barry JM, Conlin M, Golconda M, Norman D. Strategies to increase living donor kidney transplants. Urology 2005; 66(5 Suppl): 43-46. 22. Davis CL, Delmonico FL. Living-donor kidney transplantation: A review of the current practices for the live donor. J Am Soc Nephrol 2005; 16: 2098-2110. Epub 2005 Jun. 23. Eurotransplantation International Foundation. Dynamics of the Eurotransplant kidney waiting list and kidney transplants between 1969 and 2004. Available at http://www.eurotransplant.nl/files/statistics/snap.gif (accessed on October 18, 2007). 24. Delmonico F. Council of the Transplantation Society. A Report of the Amsterdam Forum On the care of the live kidney donor: Data and medical guidelines. Transplantation 2005; 79(6 Suppl): S53-S66. 25. Delmonico FL, Dew MA. Living donor kidney transplantation in a global environment. Kidney Int 2007; 71: 608-614. Epub 2007 Feb 7. 26. Siebels M, Theodorakis J, Schmeller N et al. Risks and complications in 160 living kidney donors who underwent nephroureterectomy. Nephrol Dial Transplant 2003; 18: 2648-2654. 27. Rizvi SA, Naqvi SA, Hussain Z et al. Factors influencing renal transplantation in a developing country. Transplant Proc 1998; 30: 1810-1811. 28. Johnson EM, Remucal MJ, Gillingham KJ, Dahms RA, Najarian JS, Matas AJ. Complications and risks of living donor nephrectomy. Transplantation 1997; 64: 1124-1128. 29. Alam M, Tariq WZ, Akram S, Qureshi TZ. Frequency of Hepatitis B and C in central Punjab. Pakistan J Pathol 2006; 17: 140-141. 30. Sever MS, Kazancioglu R, Yildiz A et al. Outcome of living unrelated (commercial) renal transplantation. Kidney Int 2001; 60: 1477-1483. 31. Kennedy SE, Shen Y, Charlesworth JA et al. Outcome of overseas commercial kidney transplantation: An Australian perspective. Med J Aust 2005; 182: 224-227. 32. Rook M, Hofker HS, van Son WJ, Homan Van Der Heide JJ, Ploeg RJ, Navis GJ. Predictive capacity of pre-donation GFR and renal reserve capacity for donor renal function after living kidney donation. Am J Transplant 2006; 6: 1653-1659. 33. Ishani A, Grandits GA, Grimm RH et al. Association of single measurements of dipstick proteinuria, estimated glomerular filtration rate, and hematocrit with 25-year incidence of end-stage renal disease in the multiple risk factor intervention trial. J Am Soc Nephrol 2006; 17: 1444-1452. Epub 2006 Apr 12. 34. Leanos-Miranda A, Marquez-Acosta J, Romero-Arauz F et al. Protein:Creatinine ratio in random urine samples is a reliable marker of increased 24-hour protein excretion in hospitalized women with hypertensive disorders of pregnancy. Clin Chem 2007; 53:1623-1628. Epub 2007 Jul 27. 35. Ibrahim HN, Rogers T, Tello A, Matas A. The performance of three serum creatinine-based formulas in estimating GFR in former kidney donors. Am J Transplant 2006; 6: 1479-1485. 36. Stevens PE, O'Donoghue DJ, de Lusignan S et al. Chronic kidney disease management in the United Kingdom: NEOERICA project results. Kidney Int 2007; 72: 92-99. Epub 2007 Apr 18. 37. Torres VE, Offord KP, Anderson CF et al. Blood pressure determinants in living-related renal allograft donors and their recipients. Kidney Int 1987; 31: 1383-1390. 38. Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA 2004; 291: 844-850. 39. Wrenshall LE, McHugh L, Fetton P, Dunn DL, Matas AJ. Pregnancy after donor nephrectomy. Transplantation 1996; 62: 1934-1936. 40. Katz AI, Lindheimer MD. Does pregnancy aggregate primary glomerular disease? Am J Kidney Dis 1985; 6: 261-265.