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Organ Transplantation in the Czech Republic

Bachleda, Petr, MD, PhD1; Havranek, Pavel, MD2; Navratil, Pavel, MD, PhD3; Nemec, Petr, MD, PhD4; Treska, Vladislav, MD, PhD5,6; Reischig, Tomas, MD, PhD7

doi: 10.1097/TP.0000000000002184
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1 Department of Surgery II, Vascular and Transplantation Surgery, University Hospital, Olomouc, Czech Republic.

2 Transplant Centre, Faculty of Medicine in Ostrava, Ostrava, Czech Republic.

3 Department of Urology and Transplant Centre, University Hospital and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic.

4 Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic.

5 Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Czech Republic.

6 Teaching Hospital, Pilsen, Czech Republic.

7 Department of Internal Medicine I, Faculty of Medicine in Pilsen, Charles University, Czech Republic.

Received 16 December 2017. Revision received 5 January 2018.

Accepted 6 January 2018.

The authors declare no funding or conflict of interest.

T.R. drafted and completed the article with input and revisions by P.B., P.H., P.Na., P.Ne., and V.T. All authors edited the final version and agreed with its submission.

Correspondence: Tomas Reischig, MD, PhD, Department of Internal Medicine I, Charles University Teaching Hospital, alej Svobody 80, 304 60 Pilsen, Czech Republic. (reischig@fnplzen.cz).

We have read The Report on Organ Transplantation in the Czech Republic by Ondrej Viklicky and coworkers reporting from 2 transplant centers in Prague with great interest.1 Some additional data may be helpful in providing a more detailed and well-rounded perspective on organ transplantation in the Czech Republic. The authors reported on center-specific kidney graft survival rates of 92% to 95% and 81% to 84%, by 1 and 5 years, respectively. We assume that those data represent death-censored graft survival rates in deceased donor kidney transplantation because only those have been, to the best of our knowledge, published to date from 2000 through 2010.2,3 Although the range of center-specific graft survival is not available, 5-year death-censored graft survival rates over the last 10 years have been superior in some transplant centers (90% for deceased donor kidney recipients at Pilsen transplant center).

The first laparoscopic living donor nephrectomy has been performed in Ostrava in 2002; other Czech centers have subsequently offered minimally invasive hand-assisted retroperitoneal donor nephrectomies (Brno, Hradec Kralove). At present, there is no general accepted approach for ABO-incompatible or HLA-incompatible living donor kidney transplantation in the country. ABO-incompatible living donor kidney transplantations have also been successfully performed in centers outside of the Institute for Clinical and Experimental Medicine including Hradec Kralove and Pilsen.

We agree that living donation rates have been inferior to other European countries or the United States, mainly because of very short waiting times for deceased donor transplantation. Indeed, current waiting times of 3 to 4 months in many Czech centers (Hradec Kralove, Olomouc, Ostrava, and Pilsen) allow for preemptive kidney transplantation in a substantial number of patients. In recent years, 10% to 18% of kidney transplants (mostly from deceased donors) have been performed preemptively in Pilsen and Olomouc.

Although the first Czech pediatric liver transplantation program was launched in Brno, Institute for Clinical and Experimental Medicine has currently the highest volume of this procedure. Donation after circulatory death (DCD) has a tradition of 15 years in the Pilsen transplant center where 8% of kidney originated from DCD donors between 2002 and 2016 (mostly uncontrolled, Maastricht, category II donors).4,5 Previous DCD donor activities (using uncontrolled donors, Maastricht, category II) have been reported from Hradec Kralove, and the highest volume of DCD donors (Maastricht, category III) is currently observed in Ostrava (8% of all deceased donors).

Indeed, organ transplantation in the Czech Republic is looking back to an impressive history and a strong activity of transplant centers throughout the country.

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REFERENCES

1. Viklicky O, Fronek J, Trunecka P, et al. Organ transplantation in the Czech Republic. Transplantation. 2017;101:2259–2261.
2. Kuman M. Solid organ transplantation in the Czech Republic. Vnitr Lek. 2015;61:741–746.
3. Pokorna E, Bachleda P, Dedochova J, et al. An overview of the results of renal transplantation in the Czech Republic. Vnitr Lek. 2011;57:645–649.
4. Treska V, Hasman D, Reischig T, et al. First kidney transplantation from a non-heart-beating donor in the Czech Republic. Ann Transplant. 2002;7:45–49.
5. Kootstra G, van Heurn E. Non-heartbeating donation of kidneys for transplantation. Nat Clin Pract Nephrol. 2007;3:154–163.
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