Mikhail Kaabak: "80 Percent Of Kids With Kidney Failure Are Doomed To Die"

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Mikhail Kaabak: "80 Percent Of Kids With Kidney Failure Are Doomed To Die"
Mikhail Kaabak: "80 Percent Of Kids With Kidney Failure Are Doomed To Die"

Video: Mikhail Kaabak: "80 Percent Of Kids With Kidney Failure Are Doomed To Die"

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Mikhail Kaabak: "80 percent of kids with kidney failure are doomed to die"

In Russia, the program of kidney transplantation for young children has been curtailed, which existed at the SCCH for only about six months. About what will happen to babies awaiting kidney transplantation and other problems of Russian pediatric transplantology, Takie Dela spoke with Mikhail Kaabak, a surgeon who has performed the largest number of operations in the country for low-birth-weight children.

Mikhail Kaabak: "80 percent of kids with kidney failure are doomed to die"
Mikhail Kaabak: "80 percent of kids with kidney failure are doomed to die"

Mikhail Kaabak. Photo: MosTransplant / YouTube /

In Russia, the kidney transplant program for young children has been curtailed, which existed at the National Medical Research Center for Children's Health (SCCH) for only about six months. Having received a verbal order to stop transplantation, he submitted an application of his own free will to the head. Department of Transplantation Anatoly Popa. Leading surgeons - Ph.D. Mikhail Kaabak (who left the post of head of the department of kidney transplantation at the Petrovsky Research Center of Surgery for the sake of working at the SCCH) and Ph.D. Nadezhda Babenko - received notice of dismissal. About what will happen to babies awaiting kidney transplantation and other problems of Russian pediatric transplantology, Takie Dela spoke with Mikhail Kaabak, a surgeon who performed the largest number of operations in the country for low birth weight children.

According to the surgeon, in 2018, for the first time since the beginning of regular calculations and the publication of data, a decrease was recorded in the number of already few child transplants, and in 2019 it will be even lower. And the most difficult situation is in the younger age group, where the need is satisfied by less than 20%: about 60 children appear annually - candidates for kidney transplantation under the age of 5 years, and only 10 of them are transplanted. For comparison: in Europe, where about 500 million people live, about 300 transplants are performed a year. In America, children under 5 years of age receive 150 transplants every year.

According to Kaabak, today almost all children with chronic renal failure (CRF) are on an artificial kidney machine (dialysis). Such a child brings good money to the medical institution, but almost nothing needs to be done. In addition, the economy plays a significant role: a child on dialysis brings to his clinic from 200 thousand to 500 thousand rubles a month at the rates of compulsory medical insurance, while sending him to transplant deprives the regional clinic of this money. That is, it is profitable for hospitals to dialyze a child and it is not at all profitable to send them for transplantation. Children are kept on dialysis for 2-3 years, then they die and make room for the next.

Dialysis is good, but not as a substitute for transplant, the surgeon emphasizes. Any child who goes on dialysis should automatically be placed on the transplant awaiting registry. Because children, especially toddlers, need nosebleeds to have a transplant.

Today, all transplants for young children are concentrated in Moscow. These are the RCCH, which is now experiencing severe difficulties with donor organs, the Shumakov Institute and the team of Mikhail Kaabak, which worked first at the RSCH, and since this year at the SCCH. According to Kaabaq, it is not necessary to create such a heavy infrastructure in every region. But several full-cycle centers, where there would be both pediatric dialysis and pediatric transplantation, are, of course, needed in different parts of the country. So the center practically appeared.

We thought something had changed when, at the beginning of this year, the SCCH opened a transplant program, which was supposed to increase the number of transplants for young children by an order of magnitude., - says Kaabak. - If before that, 2-3 such operations were performed annually, here we planned to do up to 40 transplants. We performed 20 operations from February to June, and 4 more from September to October. Moreover, operating here at the SCCH, we, according to the experience of the RSCH, expected that we would lose two or three children, but did not lose anyone. And this is due to the fact that the transplantation was carried out in a large multidisciplinary pediatric institution, where there are many departments dealing with various pathologies and ready to provide assistance. The SCCH could have become a brilliant training ground, but due to the sudden closure of our program in mid-September, these plans are not destined to come true and are likely to get even worse than they were before. Because no one is planning to transplant kidneys to children under 10 kg at all."

The only complaint that was voiced was the use of off-label induction therapy protocols not approved by the Ministry of Health. According to Kaabak, doctors used orphan drugs, the manufacturers of which are not interested in expanding the indications, because this status allows them to hold prices. But the receipt of a large body of evidence of the effectiveness of these drugs in non-orphan diseases forced the manufacturer to reduce the price. Moreover, one of these drugs, which are part of the induction scheme used, has so convincingly proven its effectiveness that Western governments forced the manufacturer to supply it free of charge worldwide for transplantation, which they do.

“We have a 2007 marketing authorization for the technology that allows one of the off-label drugs,” says the surgeon. - But the modern Ministry of Health does not recognize these documents. To be honest, we suspect the dishonesty of some officials who put our documents on the table, who can be financially interested in drug manufacturers, in order to prevent this technology from running. The pharmaceutical company, already at a loss, supplies this drug for transplantation free of charge by order of the European and American governments, so it is not profitable for it to be used for this purpose in Russia as well”.

Moreover, a Russian generic drug has recently appeared, the manufacturer of which, unlike the American original drug, looks positively at the expansion of indications, and is ready to meet halfway - to conduct clinical trials. But the program at SCCH has been terminated.

According to Kaabak, the most important thing now is what will happen to these children, whom, in principle, no one will transplant. “If earlier they had at least a small window into which one could get in, now all exits are closed. One child, the largest (weighs over 12 kg), has moved to the Shumakov Institute due to the closure of our program and is awaiting a cadaveric kidney transplant there. The same ten LBW children, whom we were supposed to operate here by the end of 2019, remain in limbo and in an uncertain status. Therefore, we still count on the turning point of the situation and the return of the program. I remain in my opinion: the protocol we use is 90% of the success of our operations,”says the surgeon.

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