Milestones of kidney transplantation in Indonesia

Experience of the first 6 years of pediatric kidney transplantation in Indonesia: A multicenter retrospective study

BACKGROUND

Pediatric kidney transplantation was only introduced in Indonesia in 2013. We therefore aimed to assess the characteristics and outcomes of transplants performed from its inception to January 2019.

METHOD

The study had a dual-center retrospective design. We examined the records of kidney transplant recipients and then calculated patient and graft survival rates by Kaplan-Meier survival analysis with 95% confidence intervals (95% CI).

RESULTS

In total, 12 kidney transplantations were performed in eleven children during the study period; among these, ten were boys, and nine had renal failure caused by congenital anomaly of the kidney or urinary tract. All donors were living, and all recipients were on dialysis at the time of transplantation, when their median age was 14.5 years (range, 8-19 years). Three patients died of infection in the first year of follow-up and two lost their allograft by the time of their last follow-up (median, 13 months; range, 4-69 months). The 1-year patient survival rate was therefore 68.18% (95% CI, 29.72%-88.61%), which remained unchanged at 3 and 5 years. However, the non-death-censored graft survival rates at 1, 3, and 5 years were 68.18% (95% CI, 29.72%-88.61%), 51.14% (95% CI, 14.5%-79.46%), and 25.57% (95% CI, 1.38%-64.78%), respectively.

CONCLUSION

Patient and graft survival rates after pediatric kidney transplantation in Indonesia are lower than those reported in other countries. Closer patient follow-up and stricter adherence to guidelines could improve transplant outcomes, but we must seek to improve the balance between infection and rejection.

A Study on Knowledge Towards Brain Death among Residents in Indonesia

This research was conducted to evaluate the knowledge and diagnosis of brain death among resident in Indonesia. This study used an observational analytic study with a cross-sectional study design using a questionnaire. The research subjects consisted of 132 level 2 (after 2 years of residency) and level 3 (after 4 years of residency) residents, the total sampling for which was taken from the departments of Neurosurgery, Anesthesiology, and Neurology at Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Data were taken from November 2018 to January 2019. A total of 132 residents of Neurosurgery, Neurology, and Anesthesiology participated in this study. From the series of studies, residents’ knowledge of the concept of brain death was in the sufficient category (41.7%), residents’ knowledge of the technical diagnosis of brain death was in the good category (40.2%), residents’ knowledge of brain death examination was in the less category (43.2%), and finally, it was found that the resident's knowledge of brain death was in a good category (35.6%). There were also significant differences in knowledge of brain death between Neurosurgery, Neurology, and Anesthesiologist Resident (P <0.001) and knowledge of brain death between level 2 and level 3 residents (P=0.032). In general, the Indonesian resident doctors’ knowledge of brain death is adequate, but knowledge of the clinical examination of brain death is still lacking. Further research must be carried out to promote knowledge of brain death in residents as well as professional doctors/specialists, so that the number of organ transplants, especially in Indonesia, will increase.

Kidney transplantation in Indonesia: An update

Objective

Indonesia has overcome several barriers to the growth of kidney transplantation within the past decade. Currently, the procedure is increasingly performed in several centers across the country. However there are limited publications on kidney transplantation from Indonesia, especially from centers outside Jakarta. This study aims to give a brief overview on transplantation performed, discuss current efforts and progresses of transplantation in Indonesia and chiefly Semarang.

Methods

Retrospective analysis of 20 transplant cases in Semarang during 2014–2018 was performed. Information from other transplant centers was acquired through formal correspondences with 11 central teaching hospitals in Jakarta, Surabaya, Yogyakarta, Malang, Bali, Solo, Palembang, Aceh, Medan, Bandung, and Padang.

Results

There were 629 recorded kidney transplantations performed in 12 centers, and we report on 245 cases with viable data. The average age of kidney recipients were younger (35.4 years old) compared to the donors (41.3 years old). Approximately half of the kidneys were obtained from related donors (49.0%) and there was only one case of cadaveric donor. The three leading etiologies of end-stage renal disease were hypertension (37.4%), diabetes mellitus (26.1%), and autoimmune disease (11.3%). There is only one center that has performed more than 100 kidney transplants in Indonesia.

Conclusion

Indonesia has successfully overcome several major hurdles that had previously hindered the growth of transplantation. Further improvement should concentrate on the development of integrated organ transplant infrastructure, decentralization of transplant professionals, establishment of National kidney transplant database and changing the Nation's paradigm on cadaveric organ donor through public education.

Prospect of alternative therapies to kidney transplantation

[no abstract available]