Outcome of living unrelated (commercial) renal transplantation

Background. Due to inadequate cadaveric and living related organ supply, ma ny end-stage renal disease patients go to Third World countries for commerc ial transplantation, although the high risk of complications is well establ ished and ethical arguments debate this practice. Methods. The midterm outcome of 115 patients who had been commercially tran splanted in various countries and admitted to our center for post-transplan t care and follow-up between 1992 and 1999 was retrospectively analyzed. Da ta considering the transplantation practice and post-transplant course were collected from the patient files. Outcome of these patients was compared w ith those with a living related transplant performed at our center. Results, The patients (91 male and 24 female; mean age of 42 +/- 12 years) were transplanted in India (N = 106), Iraq (N = 7), and Iran (N = 2). The m ean follow-up period was 64.5 +/- 23.9 months. Post-transplant course was c omplicated by numerous surgical and/or medical complications, and many of t he latter were unconventional infections caused by malaria, invasive fungal infections, and pneumonia due to various opportunistic pathogens. Overall, 52 patients still have functioning allografts, while 22 lost their grafts, 20 died, and 21 were lost to follow-up. Graft survival rates at two, five, and seven years were 84, 66, and 53%, respectively, for the study group, w hile it was 86. 78, and 73% for living related transplantations performed a t our center (P = 0.036). Patient survival rates for the same periods were 90, 80, and 74% for the study group and 90.85, and 80% for the living relat ed transplantations (P = 0.53). Conclusions. Besides the ongoing ethical debate, commercial transplantation carries a high risk of unconventional complications, and despite that the patient survival rate is comparable. graft survival is worse than conventio nal living related transplantations at the midterm.