{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:24:52Z","timestamp":1790706292987,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,7,30]],"date-time":"2019-07-30T00:00:00Z","timestamp":1564444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,7,30]],"date-time":"2019-07-30T00:00:00Z","timestamp":1564444800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2019,7,30]],"date-time":"2019-07-30T00:00:00Z","timestamp":1564444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The initiation of a kidney transplant program, in a low\u2010 and middle\u2010income country, while striving to maintain excellent outcomes and adhere to high ethical, legal standards, is a formidable task. Herein, we review the outcomes and challenges of a living donor kidney transplant program from its inception to sustainability, in Guyana, South America.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective review of a living donor kidney transplant program instituted in Guyana in 2008. Data included recipient and donor demographics, cause of renal failure, donor\u2013recipient matching and relationship, perioperative complications, timing and cause of death, graft failure, surgical technique, and laterality of organ procured. Patient and donor data were compared by phases and additionally compared to United States Renal Data Base System. Survival outcomes were compared by phases and by Kaplan\u2013Meier curves.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>To date, 45 kidney transplants have been completed. <jats:styled-content>Phase I (2007\u20132008)<\/jats:styled-content> was the initiation of the program, which was comprised of upgrading hospital and operating rooms, obtaining antirejection medications, educating local providers, fostering a relationship with the government, and screening patients and living donors. We also began vascular access and peritoneal dialysis in the country, as well as introduced the companion public health service initiative: the SEVAK program. <jats:styled-content>Phase II (2008\u20132014)<\/jats:styled-content> involved completion of 25 living donor kidney transplants, of which there have been 11 confirmed deaths and 10 lost to follow\u2010up. In <jats:styled-content>Phase III (2015\u2013present)<\/jats:styled-content>, 20 transplants have been completed to date, of whom only 1 died and none were lost to follow\u2010up. In the third phase, we also introduced corneal transplantation to Guyana and have performed over 100 transplants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Kidney transplantation can be safely and ethically performed in a low\u2010 and middle\u2010income country. We applied lessons learnt from the first two phases to improve follow\u2010up by appointing a local coordinator who goes to patient's homes in remote villages. Currently, there is a stable local team that is performing transplants and following the patients. We believe that our model of public\u2013private partnership can sustain kidney, as well as corneal, transplantation and could be replicated in other countries.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05093-w","type":"journal-article","created":{"date-parts":[[2019,7,30]],"date-time":"2019-07-30T16:04:02Z","timestamp":1564502642000},"page":"2658-2665","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Developing a Sustainable Renal Transplant Program in Low\u2010 and Middle\u2010Income Countries: Outcome, Challenges, and Solutions"],"prefix":"10.1002","volume":"43","author":[{"given":"Chelsea J.","family":"Guy\u2010Frank","sequence":"first","affiliation":[{"name":"Department of General Surgery UT Southwestern Dallas TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kishore","family":"Persaud","sequence":"additional","affiliation":[{"name":"Transplant Program Guyana Public Health Corporation Georgetown Guyana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dmitry","family":"Butsenko","sequence":"additional","affiliation":[{"name":"State University of New York Upstate Medical University Syracuse NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul M.","family":"Jindal","sequence":"additional","affiliation":[{"name":"USU\u2010Walter Reed Department of Surgery Uniformed Services University of the Health Sciences 4301 Jones Bridge Road 20814 Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R.","family":"Guy","sequence":"additional","affiliation":[{"name":"Abdominal Transplant Drexel University College of Medicine Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7,30]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Kidney Disease Statistics for the United States(2016)National Institute of Diabetes and Digestive and Kidney Diseases.https:\/\/www.niddk.nih.gov\/health\u2010information\/health\u2010statistics\/kidney\u2010disease. 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