The lack of cadaver organs for transplantation motivates some Balkan patients to go to developing countries to buy a kidney. We have followed 36 patients who received kidney transplants in Lahore and Rawalpindi, Pakistan. The patients had not been cleared for transplantation with a standard pre-transplant work-up: 80% were hepatitis-C virus (HCV) or HBsAg positive. During follow-up, seven patients died. Sixteen patients experienced wound infections with post-operative hernias, and three patients developed peri-renal hematomas. Six abscesses and four lymphoceles occurred, and four urinary fistulas were surgically treated. Nephrectomy was performed in three patients because of renal artery thrombosis. Nine patients developed active hepatitis C, and four patients manifested cytomegalovirus disease. Three patients developed steroid diabetes, and three patients experienced acute myocardial infarction. Nine patients had one or more rejection episodes. Urinary tract infection with Pseudomonas or Escherichia occurred frequently. The one-yr patient and graft survival rates were 80% and 68%, respectively. Paid unregulated renal transplantation is not recommended for both ethical reasons and because of an association with excessive morbidity and mortality.

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Introduction: ESRD can be characterized as a catabolic state. After renal transplantation a recovery in nutritional status occurs during the first year. Aim: Assess the changes in nutritional status and body composition after renal transplant. Patients and Methods: 83 transplant recipients (54 male, 24 female), mean age 45 ± 14 years, 65% recipients of kidneys from a deceased donor were evaluated immediately after renal transplant (baseline data) and after 6 months of follow up (FUP 6mo). Analysis included nutritional status (BMI), body composition (skin fold and arm circumference), and estimated body composition (calculated percent of fat (%fat), arm circumference (AC), arm muscle circumference (AMC) and arm muscle area (AMA)), performed by a trained examinator. Other data included diagnosis of primary renal disease, length of dialysis, renal function (MDRD), serum albumin and lipid profile obtained from medical records. Protocol was approved by local Ethics Committee. Results: At baseline evaluation (21 ± 15 days post transplant), mean BMI was 23.9 ± 3.9 kg/m 2 , with similar distribution between genders. The majority of patients had normal BMI (n=36), followed by overweight (n=22), underweight (n=12) and obese (n=13). Seum albunin (3.7 ± 0.7 g/dL) and lipid profile (cholesterol 163.5 ± 52.7 mg% and triglycerides 163.9 ± 91.8 mg%) were within normal range. Body composition analysis showed better adaptation of muscle mass in female [CB (91 ± 10.2 x 98 ± 14.6, male x fem, p <0.05), CMB (92.6 ± 1.4 x 102 , 3 ± 2.9%, male x fem, p <0.05) and AMB (87.1 ± 22.3 x 105.5 ± 25.9%, male x fem, p <0.05)]. Body fat (% fat) was above the recommended levels (adjusted for gender) in 80% of patients, increasing significantly with age, especially in female. After 6 months (FUP6mo) no significant differences in BMI, serum albumin and lipid profile was observed. However, when groups were divided according to BMI, we noticed a better renal function in normal weight group compared to overweight and obese (60 ± 17.2 vs. 39.5 ± 19.8 ml/min, MDRD, p<0.05), despite comparable eGFR at baseline. Conclusion: The nutritional assessment of patients with ESRD early after renal TX, showed that a high frequence of inadequate body composition, with increased fat and reduced lean body mass, despite a initial classified as normal (BMI: 20 and 24.9 and normal albumin). The lower GFR after 6 months of FUP needs further evaluation, but can be attributed to an inadequate renal mass or to obesity induced hyperfiltration.Disclosure: All authors have declared no conflicts of interest.

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