Kidney transplantation in Mongolia using effective and economical immunosuppression - a three-year experience

Between August 2006 and August 2009, 34 ethnic Mongolians were the recipients of a kidney transplant at the Central Clinical Hospital in Ulaanbaatar, Mongolia. In 31 of the operations the donor was either a sibling or parent. In 4 recipients the donors were 2 recently deceased accident victims following controlled cardiac arrest and after next of kin permission. All 4 recipients are alive with life-supporting function. Appropriate legislation was passed in 2008. Thirty-one of the 34 recipients (91%) are alive. The 1-year patient and graft survival is 91% and 82%, respectively. In all cases, recipients received 1 dose of Campath 1 preoperatively followed by monotherapy with either Cyclosporin or Tacrolimus. Due to the remote geographical location of some of the recipients, appropriate serum drug levels were difficult to monitor. Azathioprine was therefore added in the last 13 recipients. Except for acute rejection episodes, no patients received steroid therapy. There were 7 diagnosed and treated acute rejections in the 34 recipients (21%). The mean annual cost of the immunosuppressive therapy period compared favorably with neighboring China and with costs in Spain. We conclude that the use of Campath 1 together with a non-steroid maintenance immunosuppressive regimen provides both economical and acceptable graft and patient survival in a developing country.