Abstract
This article describes the background, beginnings, development, evolution and outcomes of kidney transplantation in Cuba. Nephrology as a medical specialty in Cuba began in 1962 and was formalized in 1966. Conditions were created to implement renal replacement therapy (including transplants), bring nephrology care to the entire country and train human resources who would assume this responsibility, making Cuba one of the first countries with a comprehensive program for renal patient care. After three unsuccessful cadaveric-donor kidney transplantations in 1968-69, the ensuing history of kidney transplantation can be summarized in the following three stages. 1970-1975: In January 1970, cadaveric-donor kidney transplantation began at the Nephrology Institute. That year, 17 kidney transplantations were performed; four of these patients lived with functional kidneys for 15-25 years; 10-year graft survival was 23.5% (Kaplan-Meier survival curve); HLA typing began in 1974. By December 1975, 170 grafts had been done in three hospitals. 1976-1985: Seven transplantation centers performed 893 grafts during this period. HLA-DR typing was introduced in 1976 and the National Histocompatibility Laboratory Network was founded in 1978. The first related living-donor kidney transplantation was done in 1979. 1986-2011: The National Kidney Transplantation Coordinating Center and the National Kidney Transplantation Program were created in 1986; the first combined kidney-pancreas transplantation was performed the same year. In 1990, cyclosporine and the Cuban monoclonal antibody IOR-T3 were introduced for immunosuppression to prevent rejection, as were other Cuban products (hepatitis B vaccine and recombinant human erythropoietin) for transplant patients. By December 2011, the cumulative number of transplants was 4636 (384 from related living donors). With over 40 years of experience, kidney transplantation is now well established in Cuba; it is free and universally accessible, on the basis of need and appropriateness.
Highlights
Kidney dialysis and transplantation arose from the need to treat patients with end-stage renal disease
Scientific advances led to the development of an artificial kidney for clinical use in the 1940s and successful kidney transplantation in the 1950s, inaugurating a new era in organ transplantation
The objective of this paper is to describe the history of kidney transplantation in Cuba, looking at its background, beginnings, development, evolution and outcomes
Summary
Kidney dialysis and transplantation arose from the need to treat patients with end-stage renal disease. In Cuba, three different surgical teams each performed a kidney transplantation in 1968 and 1969 They grafted kidneys from cadaveric donors with cardiac arrest—matched solely on blood group compatibility—into three young male patients, two with end-stage renal disease of unknown etiology and one whose only kidney had to be removed because of uncontrollable traumatic hematuria. Following consent from their families, kidney transplantations were done as a last attempt to save the patients’ lives, despite risks involved and paucity of related resources, experience and scientific knowledge at the time.[5] None of the transplants was successful, the patients dying within a few days postoperatively, among other reasons from lack of a program for repeated dialysis.[5]. The objective of this paper is to describe the history of kidney transplantation in Cuba, looking at its background, beginnings, development, evolution and outcomes
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