Implementation of a pediatric kidney transplantation program in Uzbekistan: Feasibility and early outcomes

doi:10.5500/wjt.v15.i4.107728

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 15, Issue 4

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (27)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-4) series, Tables (1-2) series.

Item

Count

PDF

HTML

Figures (1-4)

Tables (1-2)

Sum=23

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=0

Dec 18, 2025 (publication date) through Nov 19, 2025

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Transplantation

ISSN

2220-3230

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Transplant. Dec 18, 2025; 15(4): 107728
Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.107728

Implementation of a pediatric kidney transplantation program in Uzbekistan: Feasibility and early outcomes

Konstantin Semash, Akrom Akhmedov, Timur Dzhanbekov, Qosimjon Umarov, Jurabek Dustmurodov

Konstantin Semash, Timur Dzhanbekov, Qosimjon Umarov, Jurabek Dustmurodov, Department of Minimally Invasive Pediatric Surgery and Transplantation, National Children's Medical Center, Tashkent 100171, Toshkent, Uzbekistan

Akrom Akhmedov, Department of Vascular Surgery and Kidney Transplantation, V. Vakhidov Republican Specialized Scientific and Practical Medical Center of Surgery, Tashkent 100115, Toshkent, Uzbekistan

Author contributions: Semash K oversaw and coordinated all administrative aspects, including study planning, logistics, and compliance with ethical and regulatory standards; Semash K provided overall clinical and methodological supervision throughout the study, ensuring accuracy, scientific validity, and adherence to transplant protocols; Semash K developed the original concept of implementing the pediatric kidney transplantation program and formulated the overall goals and objectives of the study; Semash K, Akhmedov A, Dzhanvekov T, and Umarov Q established the clinical and research methodology, including donor selection criteria, surgical protocols, immunological assessments, and postoperative management guidelines; Semash K conducted statistical analysis, including interpretation of perioperative outcomes, complication rates, graft function parameters, and survival analysis; Dzhanbekov T, Semash K, and Akhmedov A provided essential resources, including surgical instruments, medical supplies, equipment for diagnostics and postoperative care, and access to laboratory and imaging facilities; Semash K, Dzhanbekov T, Umarov Q, and Dustmurodov J collected, organized, verified, and maintained data records from clinical observations, patient follow-up, laboratory results, and imaging studies; Semash K prepared and organized all visual data, including creating and reviewing figures, diagrams, and tables to clearly represent clinical outcomes and surgical techniques; Semash K drafted the initial manuscript, structured the text, and compiled data into a coherent and scientifically rigorous narrative; Semash K, Akhmedov A, Dzhanbekov T, Umarov Q, and Dustmurodov J critically reviewed the manuscript, provided substantial intellectual input, revised the content, and approved the final version for submission.

Institutional review board statement: The study «Implementation of a Pediatric Kidney Transplantation Program in Uzbekistan: Feasibility and Early Outcomes» was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board (IRB) of the National Children’s Medical Center, protocol number #738-77-2025, dated March 05, 2025. Written informed consent was obtained from all participants or their legal guardians, ensuring the confidentiality and anonymity of patient data throughout the research process.

Informed consent statement: The study was approved by the Institutional Review Board of the National Children’s Medical Center, Tashkent, Uzbekistan (IRB statement #738-77-2025). The patients provided written consent allowing the use of medical data for scientific research while ensuring the anonymity of the patients.

Conflict-of-interest statement: All the authors declare no actual or potential conflicts of interest.

Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request. All requests for data should clearly specify the purpose, methodology, and scope of the intended research. Data will be provided in an anonymized format to ensure patient confidentiality and compliance with institutional ethical guidelines.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Konstantin Semash, MD, PhD, Department of Minimally Invasive Pediatric Surgery and Transplantation, National Children's Medical Center, Parkent Street 294, Tashkent 100171, Toshkent, Uzbekistan. doctorsemash@gmail.com

Received: April 1, 2025
Revised: April 14, 2025
Accepted: May 18, 2025
Published online: December 18, 2025
Processing time: 236 Days and 11.2 Hours

Abstract

BACKGROUND

Pediatric kidney transplantation is the treatment of choice for children with end-stage renal disease; however, access to transplantation remains limited in low- and middle-income countries. Uzbekistan had no prior institutional experience in performing pediatric living donor kidney transplantation (LDKT).

AIM

To report the implementation, surgical protocols, and clinical outcomes of the first pediatric LDKT program in Uzbekistan.

METHODS

This retrospective single-center study analyzed the first 20 pediatric LDKTs performed between April 2023 and February 2025. All donors were related family members who underwent either open or laparoscopic hand-assisted nephrectomy. Pre-transplant immunologic workup included HLA typing and anti-HLA antibody screening using solid-phase assays. Perioperative management was guided by Enhanced Recovery After Surgery Society principles. Primary outcomes included operative metrics, perioperative complications, graft function, biopsy-proven rejection, and patient/graft survival. Statistical analysis utilized descriptive statistics, Kaplan–Meier survival estimates, and Fisher’s exact test where applicable.

RESULTS

Donors included 13 women and 7 men (median age: 38 years; range: 31–50). Median operative times were 182.5 minutes for open nephrectomy and 198.5 minutes for laparoscopic nephrectomy. No major intraoperative complications occurred; one donor developed a postoperative wound seroma. All recipients (aged 87–207 months) exhibited immediate graft function, with no delayed graft function observed. Median cold and warm ischemia times were 15 minutes (range: 10–138) and 35 minutes (range: 18–40), respectively. Median serum creatinine decreased from 198 μmol/L on postoperative day 1 to 54 μmol/L by day 7. Three rejection episodes were reported, two of which occurred in sensitized recipients. Two graft losses were attributed to late rejection. One patient died from hemorrhagic stroke six months post-transplant. At 24 months, patient and graft survival rates were 95% and 90%, respectively.

CONCLUSION

The successful implementation of a pediatric living donor kidney transplantation program in Uzbekistan yielded favorable short- and intermediate-term outcomes, with high graft survival and low complication rates. This experience may provide a practical framework for initiating similar programs in other resource-constrained healthcare settings.

Keywords: Kidney transplantation; Pediatric kidney transplantation; Living-related donors; Uzbekistan; Graft survival; Immunosuppression; Transplantation outcomes

Core Tip: This is the first report on the establishment of a pediatric kidney transplantation program from living-related donors in Uzbekistan. We present detailed surgical techniques, immunological screening protocols, and early clinical outcomes based on the first 20 transplantations. All recipients demonstrated immediate graft function without delayed graft function. At 24 months, patient survival was 95% and graft survival was 90%. This study demonstrates the feasibility, safety, and effectiveness of introducing pediatric kidney transplantation in a limited-resource setting, and may serve as a practical model for developing similar programs in other low- and middle-income countries.