American University of Beirut Medical Center
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Division of Urology
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Specialties: Transplantation

The AUBMC has established a state-of-the-art center for managing end-stage kidney disease since 1997. In the past five years, we have extended this program to a multi-disciplinary, multi-departmental service (Medicine, Nephrology, Infectious Diseases, Hepatology, Surgery, Urology, Pathology (Laboratory Medicine) and the Department of Immunology).

We are an affiliate of the University of Massachusetts Transplantation Center and currently are applying the same protocols. We have performed over 110 renal transplants in the past 4 years that have enjoyed 97% graft and patient success rate. The enormous success and low grade of graft rejection (<8%) in over 120 patients treated with triple immunosuppression (Cyclosporine Neoral, Mycophenolate Mofetil and Prednisone) is probably a result of modern immunosuppressive protocols and less toxic agents than prior induction protocols using monoclonal and polyclonal antibodies. The use of meticulous surgical techniques and rapid steroid tapering has abolished the postoperative wound infection and pulmonary complications. Study protocols have included the evaluation of triple and quadruple immunosuppressive protocols in modulating chronic allograft rejection. We are also evaluating chronic rejection and have presented on this subject in several international and national meetings. In addition we have published on diminishing the rate of chronic allograft rejection, which remains the major cause of graft loss after kidney transplantation.

Despite our interests and dedicated efforts to promote organ donation, the number of cadaver organ donors remains small in the country. This is probably complicated by hurdles like cultural complexities as well as geographic and religious restrictions, and has prohibited the expansion of the cadaveric transplant program, which remains a rare occurrence in Lebanon. The AUBMC utilizes mostly live donor organs as well as the expanded-emotionally-related living donation in the past year.

The AUBMC continues to see its share of referrals from external transplant programs with major surgical and medical complications. The staff is represented in several prestigious societies, like The American Society of Transplant Surgeons and Physicians, The Urologic Society for Transplantation and Renal Surgery and The International Transplant Society. The enormous clinical success of the transplantation program has resulted in continued referral from Middle Eastern and Arab States as well as Turkey and Europe. As mentioned previously, our ongoing clinical research, especially that on chronic allograft rejection and ameliorating the process, in the conjunction of the University of Massachusetts Medical Center has led to several original publications on the subject and participation in international scientific programs.

In the past 4 years, AUBMC has initiated the first Laparoscopic Donor Nephrectomy Program in the Middle East. Over 90 donor-recipient transplants have been performed using laparoscopically- retrieved kidneys, with excellent graft success rates (95%); similar to the outcome achieved with the open- nephrectomy received kidneys. In a recently published controlled trial comparing the outcome of transplantation based on kidney retrieval technique (open versus laparoscopic donor nephrectomy), there was no difference in graft function or recipient outcome in these arms, but there was a clear benefit to the donor in the laparascopic nephrectomy arm with significantly shorter recovery and resumption of normal activity.

Division of Urology American University of Beirut Medical Center Department of Surgery