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Kidney Week

Abstract: SA-PO844

Kidney Transplant In Mentally Challenged Patients: A Single Centre Experience

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Yagan, Jude A., Organ transplant centre, Kuwait, Kuwait
  • Mahmoud, Tarek Said Hamed, Organ transplant centre, Kuwait, Kuwait
  • Gheith, Osama, Organ transplant centre, Kuwait, Kuwait
  • Mostafa, Mohamed M., Organ transplant centre, Kuwait, Kuwait
Background

kidney transplant (KTx) is the best treatment for end-stage kidney disease (ESKD). Some medical conditions, like psychological and neurological status of the recipient, may pose ethical and legal questions on kidney allocation especially if medical improvement is not expected. Conversely, there is an obligation to provide the best care for this vulnerable group.

Methods

We retrospectively studied 10 children with a background of mental difficulties with variable severity, most had urological developmental abnormalities as the cause of ESKD. Children had KTx from all types of donors.
7 children were without a labeled diagnosis (global developmental delay, cerebral palsy), one had Jeune syndrome (received combined deceased donor liver and KTx), 1 had Laurence-moon-Biedl syndrome, 1 with Down syndrome. We interviewed the families during outpatient visits asking questions about improved quality of life, social/emotional well-being,medication adherence.

Results

10 children were followed for up to 23 years, the mean age at transplant time was 7.8 years. 4 had LRKTx, similar number had DDKTx, 2 had LUKTx. Mean serum creatinine of 135umol/l upon the last follow-up.The main benefit was relieving families from the burden of maintaining HD/PD and providing a better quality of life.The general misconception about inability to follow complex medication regimens or nonadherence in this group is highly contested in this cohort. Good caregiver support (family member/housemaid) ensured timely given medications on top of good support/medical education in our center. There were no rejection episodes or prolonged hospitalization except for mild infections (UTIs, chest infections).

Conclusion

Mentally challenged patients shouldn't be denied KTx based only on their mental condition. Issues of nonadherence can be overcome with stable family support even in patients with devastating neurological dysfunction. It will solve the ethical issues surrounding depriving this group of the best care while ensuring no waste of precious organs.