BACKGROUND: In-depth understanding of cultural and religious factors limiting organ donation of three ethnic populations (Malay, Chinese, and Indian) in Southeast Asia is lacking. Identification of factors limiting organ donation among these three ethnic groups will provide insights into culturally appropriate strategies to promote acceptance of organ donation in a multiethnic Asian community.
METHODS: A total of 17 focus group discussions (105 participants) were conducted between September and December 2008. Participants were members of the general public aged 18 to 60 years, recruited through convenient sampling around the Klang Valley area of Malaysia.
RESULTS: Although the majority had favorable attitudes toward deceased organ donation and transplantation, a diversity of myths and misinformation were unearthed from the discussions across the ethnic groups. These include perceived religious prohibition, cultural myths and misperceptions, fear of disfigurement, fear of surgery, distrust of the medical system, and family disapproval. Culture and religious beliefs played important prohibitive roles among those opposed to organ donations. There were distinctive ethnic differences in cultural and religious concerns regarding organ donation. Less-educated and rural groups appeared to have more misconceptions than the well-educated and the urban groups.
CONCLUSION: Our findings may assist organ donation and transplantation organizations to reach diverse sociodemographic and ethnic communities with culture-specific information about organ donation. The involvement of community and religious leaders is critical in organ donation requests.
Delayed graft function is a potentially challenging problem especially in cadaveric kidney transplant recipients. It adversely impacts long-term graft survival. It is rarely seen in living kidney transplants. Recovery of graft function usually occurs within a month. The chances of recovery of graft function diminish with further prolongation of delayed function. In fact, recovery of graft function after 3 months has rarely been described, we report herein recovery of graft function after 132 days of nonfunction in a living related kidney transplant.
Angiofollicular lymphoid hyperplasia (Castleman's disease) is a lymphoproliferative process thought to be mediated by overexpression of II interleukin-6. Castleman's disease has two variants: Castleman's disease has two variants: Hyaline vascular type and plasma cell variant (multicentric Castleman's disease). The hyaline vascular type tends to be localized, and the plasma cell variant shows more systematic signs and carriers a worse clinical prognosis. Castleman's disease is associated with B-cell lymphoma, Kaposi sarcoma, Human herpes virus 8 (HHV-8), and Epstein-Barr virus. Castleman's disease have been described thrice post kidney transplant. In this report, we document the course of a renal recipient who developed the plasma cell variant of Castleman's disease at 16 months after failure of his allograft and return to dialysis. He displayed clinical resolution of this complication after graft nephrectomy. To our knowledge, this is the first case where the disease manifestations disappeared after graft removal. Our patient experienced chronic renal allograft rejection which may have driven all the systematic manifestations of multicentric castleman's disease and possibly reactivated a latent HHV-8 infection. In this case immunohistochemical testing for HHV-8 was not available to prove a role for this agent.
The Asian Society of Transplantation, founded in 1989 includes Indonesia, Japan, Korea, Malaysia, Oman, Pakistan, Republic of China, Philippines, Saudi Arabia, Singapore, Taiwan, Thailand, and the United Arab Emirates (UAE). The registry was also started from the same year in cooperation with these 16 countries. A questionnaire was sent to the key person of each country every year. The questionnaire includes (a) number of centers that performed organ transplants, (b) varieties and numbers of organ transplants performed in 2000 and 2001, (c) present status of dialysis, number of dialysis patients, and number of the candidates on the list for transplantation, (d) number of patients going abroad for transplantation, and (e) recent transplant highlights, news and issues affecting each country during 2000 and 2001. We previously gathered data for 2000, except for Indonesia, Singapore, and the UAE. Regarding 2001 data, we will send the questionnaires to the countries involved.
Catheter angiography is traditionally used to determine renal arterial anatomy in live renal donors. Three-dimensional (3D) contrast-enhanced magnetic resonance imaging (MRA) has been suggested as a noninvasive replacement. We assessed the possibility of using MRA in live renal donors in Malaysia.
OBJECTIVE:
This study reviewed the incidence of post-transplantation diabetes mellitus (PTDM) and risk factors for its development among renal transplant recipients in Malaysia.
METHODS:
Records of all kidney recipients with no known diabetes mellitus prior to transplantation and followed for at least 6 months posttransplant were selected for this retrospective study. PTDM was diagnosed according to American Diabetic Association/WHO criteria or the need to start insulin or an oral hypoglycemic agent. The data set included recipient age, gender, race, weight, donor type, duration of transplant, HCV antibody status, and immunosuppressive medication.
RESULTS:
Of the 316 patients who fulfilled the selection criteria, 13.3% had PTDM. Gender, race, type of donor, HCV serologic status, and use of tacrolimus did not differ significantly between recipients with versus without PTDM. However, recipients who developed PTDM were significantly older (median age 50.5 versus 42.0 years, P < 0.0001), had significantly longer posttransplant follow-up (median duration 125.5 versus 85.0 months, P = .0030) and weighed more at transplantation/first follow-up (median weight 57.6 versus 52.3 kg, P = .0103).
CONCLUSION:
The overall cumulative incidence of PTDM in this study was similar to the published reports. Older age, longer posttransplant duration, and heavier weight were the only variables significantly associated with PTDM.
Bioelectrical impedance analysis was introduced more than a decade ago to measure body composition and nutritional status. There are presently limited data on the nutritional status and body composition measured with bioelectrical impedance analysis in renal transplant recipients, especially among the Asian population. The normal values for these data in renal transplant recipients remain unknown.
BACKGROUND: The aim of this study was to compare the within-patient variability trough levels (Co), dose-adjusted Co, and dose requirements of Prograf and Advograf with CYP3A5 polymorphisms in Malaysia renal transplant recipients.
METHODS: Stable post-renal transplantation patients switched from Prograf to Advograf were retrospectively identified from University Malaya Medical Centre (n = 28). Co and concomitant tacrolimus dose 6 months preconversion and postconversion were examined. CYP3A5 was genotyped using reverse transcriptase polymerase chain reaction. Wilcoxon signed rank test and Mann-Whitney U test were used to compare Co and dose between formulations and according to genotypes.
RESULTS: There was a significant difference in the whole-blood tacrolimus Co between the 2 groups (6.16 ± 1.74 ng/mL vs 4.90 ± 1.06 ng/mL; P = .0001). The mean daily maintenance dose of Prograf was 3.9 ± 2.0 mg/kg (0.06 mg/kg/d), which was reduced to 3.3 ± 1.7 mg/d (0.04 mg/kg/d) with Advograf (P = .01). The mean maintenance dose of tacrolimus required for those with CYP3A5*1/*1 (high-expressive) was significantly higher than those with CYP3A5*1/*3 (intermediate-expressive) and CYP3A5*3/*3 (low-expressive) (P < .01) for both formulations. Comparing those with CYP3A5*1/*1, the average dose-adjusted Co was significantly higher in patients with CYP3A5*3/*3 with Advograf (P < .05).
CONCLUSIONS: The requirement for daily maintenance dose was higher in those with CYP3A5*1/*1 variants in both tacrolimus formulations in the Malaysian patients. Furthermore, those with CYP3A5*3/*3 demonstrated significantly higher dose-adjusted Co with Advograf.