Dear Editor,
I READ in the Kaieteur News of kidney transplant patients being in a dilemma because of the apparent absence of anti-rejection drugs.
Mr. Editor, please permit me to explain why these drugs are important. Our immune system is like our army: It defends us from all foreign invasions via assassins call white blood cells. So, if you are to develop an infection, the body would view that infective agent as foreign, and attack and kill it, hence saving your life.

When someone has a kidney transplant, that transplanted kidney would be viewed as foreign, since it is not native to the recipient. As a result, the immune system will attack and destroy it. To stop this from happening, patients with transplanted organs are given immunosuppressant drugs to sedate the immune system, hence allowing the transplanted kidney to live in peace. I predicted that problem last year. I wrote about it on many occasions. I clearly stated that GPHC lacks the basic skills for kidney transplants, and to manage the transplanted kidney.

Secondly, upon reading the article, I’ve gotten the impression that the only immunosuppressant these transplants are receiving is mycopnenolate. This is not consistent with international standards. After a kidney transplant, the patient is risk-stratified on their chances of rejection. Those at high risk of rejection require at least three types of immunosuppressants. Those at low risk require two. Most patients would commonly be on calcineurin inhibitors, usually tacrolimus, because of its lower risk of side effects when compared to ciclosporin.

In addition to calcineurin inhibitors, mycophenolate could be used. For high-risk patients, steroids are added.
The calcineurin inhibitors require regular blood monitoring, which is not available in Guyana. If the patients start to have dysfunction of the transplanted kidney, then special investigations are needed, which is not available in Guyana. Some patients may require biopsy under ultrasound guidance, which is not available in Guyana. To examine the biopsied kidney, a histopathologist is required to examine it, with supporting staff to prepare the samples. And many more Mr. Editor.

I wrote about this many times, outlining my reasons, supported by medical evidence, and I was attacked on Facebook. In my letter, I predicted that because of the lack of facilities in Guyana, those transplanted kidneys would last less than five years. A live donor-related transplant can last up to 30 years. In effect, doing kidney transplants in Guyana is a complete waste of time without the necessary pre and post- management care, and should be aborted forthwith.

Regards,
Dr. Mark Devonish MBBS MSc MRCP(UK) FRCP(Edin)
Consultant Acute Medicine 
Nottingham University Hospital
UK