HEALTH CARE IN CUBA

KIDNEY TRANSPLANT PROGRAM


Kidney transplant surgery has been carried out in Cuba since 1970 and it stands out as the therapeutic modality that brings more quality of life to patients that suff er from terminal chronic kidney failure. The implant of a new kidney gives these patients prospects for their reincorporation to a practically normal life and the psychological wellbeing of not depending on artifi cial kidneys.

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TREATMENTS


AFTER THE FIRST LIVER TRANSPLANTATION in 1963, many in the medical community thought good results would be difficult. But technical advances over the following years led to the possibility of starting successful programs, mainly in the First World countries. The first successful liver transplantation in Cuba was performed on July 17, 1987, although the liver transplantation program proper did not start until July 4, 1999. From then until October 30, 2003, we performed 66 orthotopic liver transplantations (OLTs). For Third World countries, starting and maintaining one of these programs is extremely challenging, mostly for economic reasons. In this study we present the results of our program over the first 4 years.


TO OCTOBER 2003

we performed 66 liver transplant procedures in 60 patients. Two were simultaneous liver-kidney transplants, and 6 were repeat transplants. Thirty patients were male, and 30 were female. The most common reason was noncholestatic advanced chronic liver disease, mainly from cirrhosis caused by hepatitis C virus (29%) and alcoholic cirrhosis (22%). Piggyback surgery was performed in 97% of the cases. No venovenous bypass was used. Biliary tract reconstruction was undertaken using 1 of 3 techniques. The first, in 44 patients, was choledochocholedochostomy (CCS) with a T tube, with 22.72% complications. The second was the same CCS but without a T tube and with a TUTOR in 19 patients. This technique was associated with 21.5% complications. Finally, hepaticojejunostomy was used in 3 patients when the other techniques were not feasible for anatomic reasons or because of causes related to the underlying hepatobiliary disease. Vascular complications included hepatic arterial thrombosis (12%) and suprahepatic venous thrombosis (3.3%). Six patients (10%) required another operation to treat hemorrhage in the early post-surgical period. Acute cellular rejection was noted in 24.2% of patients, 43.75% of whom had hepatitis C virus.

KIDNEY TRANSPLANT PROGRAM:

It’s a medical-surgical procedure aimed at treating patients that suff er from terminal chronic kidney failure (IRCT is the Spanish acronym). The objective is to restore the renal function by implanting a kidney, given by a donor (alive in this case), which is compatible with the patient. This procedure help patients have higher quality of life and foster their social reintegration, which is the ultimate goal of the intervention. This program includes preoperative assessment, surgical treatment and post-operation assessment of the donor-receiver pair.

THE SERVICES COMPRISED IN THIS PROGRAM ARE:

KIDNEY TRANSPLANT
ASSESSMENT PROGRAM FOR KIDNEY TRANSPLANT (RECEIVER AND DONOR)
KIDNEY TRANSPLANT (RECEIVER AND DONOR).



CARE WITH HOSPITALITY

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