Background: Deceased and live-related renal transplants (RTXs) are approved procedures that are performed widely throughout the world. In certain regions, commercial RTX has become popular, driven by financial greed. Methods: This retrospective, descriptive study was performed at the Royal Hospital from 2013 to 2015. Data were collected from the national kidney transplant registry of Oman. All transplant cases retrieved were divided into two groups: live-related RTX performed in Oman and commercial-unrelated RTX performed abroad. These groups were then divided again into those with and without evidence of fungal infection, either in the wound or renal graft. Results: A total of 198 RTX patients were identified, of whom 162 (81.8%) had undergone a commercial RTX that was done abroad. Invasive fungal infections (IFIs) were diagnosed in 8% of patients who had undergone a commercial RTX; of these patients, 76.9% underwent a nephrectomy and 23.1% continued with a functioning graft. None of the patients with RTXs performed at the Royal Hospital contracted an IFI. The most common fungal isolates were Aspergillus species (including Aspergillus flavus, Aspergillus fumigatus, Aspergillus nidulans, and Aspergillus nigricans), followed by Zygomycetes. However, there was no evidence of fungal infection including Aspergillus outside the graft site. Computed tomography (CT) findings showed infarction of the graft, renal artery thrombosis, aneurysmal dilatation of the external iliac artery, fungal ball, or just the presence of a perigraft collection. Of the total patients with IFIs, 23.1% died due to septic shock and 53.8% were alive and on hemodialysis. The remaining 23.1% who did not undergo nephrectomy demonstrated acceptable graft function. Conclusions: This is the largest single-center study on commercial RTX reporting the highest number of patients with IFI acquired over a relatively short period of time. Aspergillus spp were the main culprit fungi, with no Candida spp being isolated. A high index of suspicion might be the most reasonable means to reduce the possible very poor outcomes. Improving legal transplant programs and strengthening the associated laws could prevent commercial transplant tourism. © 2018 The Authors

Commercial transplant Invasive fungal infection Immunosuppression Renal transplant Transplant tourism Epidemiology

living donor human systemic mycosis diagnostic imaging Humans Adolescent male diabetic nephropathy antifungal therapy female hemodialysis Renal Dialysis echography prevalence isolation and purification Article major clinical study adult Oman medical tourism Child end stage renal disease nephrolithiasis rapamycin clinical feature middle aged corticosteroid therapy Aged septic shock Young Adult immunosuppressive treatment classification cotrimoxazole Retrospective Studies antibiotic prophylaxis nystatin Nephrectomy computer assisted tomography outcome assessment retrospective study basiliximab methylprednisolone tacrolimus kidney graft rejection Zygomycetes thymocyte antibody amphotericin B lipid complex Aspergillus Incidence cyclosporine descriptive research unrelated donors perigraft collection surgical wound debridement Aspergillus flavus vesicoureteral reflux Tomography Scanners, X-Ray Computed hemorrhagic shock Invasive Fungal Infections chronic glomerulonephritis renal artery thrombosis immunotherapy valganciclovir computed tomography scanner mycophenolic acid Aspergillus fumigatus pentetate technetium tc 99m renovascular hypertension Follow-Up Studies follow up fungus ball fungus isolation kidney infarction false aneurysm everolimus acute kidney tubule necrosis Aspergillus nidulans iliac artery aneurysm Aspergillus nigricans prednisolone opportunistic infection maintenance therapy Kidney Transplantation hematoma