Department of Urology, Sindh Institute of Urology and Transplantation, Dewan Farooq Medical Complex, Karachi, Pakistan.
Am J Transplant. 2013 Sep;13(9):2441-9. doi: 10.1111/ajt.12356. Epub 2013 Jul 19.
The prevalence of pediatric RRT and transplantation are low in developing countries, 6-12 and <1 to 5 per million child population (pmcp), respectively. This is due to low GDP/capita of <$10 000, government expenditure on health of <2.6-9% of GDP and paucity of facilities. The reported incidence of pediatric CKD and ESRD is <1.0-8 and 3.4-35 pmcp, respectively. RRT and transplantation are offered mostly in private centers in cities where HD costs $20-100/session and transplants $10 000-20 000. High costs and long distance to centers results in treatment refusal in up to 35% of the cases. In this backdrop 75-85% of children with ESRD are disfranchised from RRT and transplantation. Our center initiated an integrated dialysis-transplant program funded by a community-government partnership where RRT and transplantation was provided "free of cost" with life long follow-up and medication. Access to free RRT at doorsteps and transplantation lead to societal acceptance of transplantation as the therapy of choice for ESRD. This enabled us to perform 475 pediatric transplants in 25 years with 1- and 5-year graft survival of 96% and 81%, respectively. Our model shows that pediatric transplantation is possible in developing countries when freely available and accessible to all who need it in the public sector.
发展中国家儿科肾脏替代治疗（RRT）和移植的普及率较低，分别为每百万儿童人口中 6-12 人和<1-5 人。这是由于这些国家的人均国内生产总值（GDP）较低（<$10000），政府卫生支出占 GDP 的比例较低（<2.6-9%），且设施匮乏。据报道，儿科慢性肾脏病（CKD）和终末期肾病（ESRD）的发病率分别为<1.0-8 和 3.4-35/百万儿童人口。RRT 和移植主要在城市的私立中心提供，那里的血液透析费用为每次 20-100 美元，移植费用为 10000-20000 美元。高昂的费用和到中心的长途跋涉导致多达 35%的病例拒绝治疗。在这种情况下，75-85%的 ESRD 患儿无法接受 RRT 和移植。我们的中心发起了一项由社区-政府合作资助的综合透析-移植计划，在这里，RRT 和移植是“免费”提供的，并提供终身随访和药物治疗。在当地就能获得免费的 RRT 和移植，这使得社会接受了移植作为 ESRD 的首选治疗方法。这使我们能够在 25 年内完成 475 例儿科移植，1 年和 5 年移植物存活率分别为 96%和 81%。我们的模式表明，当儿科移植在公共部门向所有有需要的人免费提供并可获得时，在发展中国家也是可行的。
