Kidney Transplantation in Syria

Dr. Ahmad Ojjeh
General Director of Damascus Hospital

WHO: ESRD in the World

More than 2,000,000 people on dialysis

90% are in North America, Japan & Europe (20% of world population)
10% rest of world
(80% of world population)

The number of patients with ESRD worldwide is rising
markedly (5-8% per year).

Syrian Population 20 millions

ESRD prevalence in Syria 100 - 150/pmp/year

END-STAGE RENAL DISEASE:

TOP 3 CAUSES
Diabetic nephropathy
Chronic glomerulonephritis
Hypertensive nephrosclerosis

RENAL REPLACEMENT THERAPY

Hemodialysis
Peritoneal dialysis
Kidney transplantation
 

Hemodialysis in Syria


Harasta military hospital - Damascus  ( Tank System )  1973

HD patients per million

Syria: ( ~ 5000 Pt. ) 223 per million
Developed countries: 500 – 600 per million

Geographic distribution of HD patients in Syria

( M.O.H )

PD in Syria

PD is underused in Syria ( less than 3% )

KIDNEY TRANSPLANTATION

Kidney transplantation is like a marriage,
it is a blessing for many,
curse for some,
but a risk for all.

First Transplants

1954 - Kidney Murray - Boston
1966 - Pancreas Lillehei - Minneapolis
1967 - Liver Starzl - Denver
1967 - Heart Bernard - Cape Town
1981 - Heart/Lung Reitz - Stanford
1983 - Lung Cooper - Toronto

Renal Transplantation History
1954 Identical Twin Transplants.
1961 first transplant done using azathioprine. Move beyond identical twins: siblings, parents,
children.
1982 Cyclosporine makes HLA matching less important:
unrelated donors and distant relatives.
Efforts to transplant ABO incompatible donors recipient
pairs.

60’s and early 70’s NHBD
Late 70s early 80s rationalization of equivalence
between neurological and cardiac death.
NHBD virtually ceases
1981 Uniform Determination of Death Act (Presidents’
Commission)
Potential recipient population continues to rise
HBD rates start to decrease from the early 1990s
1993 Pittsburgh protocol for NHBD renews interest

WHAT ARE THE BENEFITS OF ORGAN DONATION?

Saving lives: organ transplantation gives people who
would otherwise die a second chance to live

Quality of life: for people who depend upon dialysis
machines, it means the return to a normal, productive
lifestyle

Cost effectiveness: organ transplantation can be more
economical on the long term than other forms of medical
treatment

KIDNEY TRANSPLANTATION

THE FIRST RENAL TRANSPLANT IN THE MIDDLE EAST WAS
PERFORMED IN JORDAN IN 1972 AT THE ROYAL MEDICAL
SERVICES