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A Scoping Review of Kidney Transplantation in Africa: How Far have We Come?

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Abstract

Introduction

Kidney transplantation is a life-saving treatment for end-stage kidney disease (ESKD) patients. However, access to this treatment in Africa lags behind other regions, leading to significant disparities in care. We aimed to analyse the indications, demographics, and outcomes of kidney transplantation in Africa.

Method

We conducted a systematic review of studies from PubMed, Google Scholar, and African Journal Online using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We pooled and analysed data on procedure type, graft outcomes, donor type, prophylaxis, post-operative complications, and survival from 33 eligible studies.

Result

The most common causes of ESKD requiring transplantation were glomerulonephritis and nephroangiosclerosis. Open nephrectomy was the predominant surgical approach (95%). Living donors accounted for 56.3% (4221) of all donors, with 68.5% being related to the recipient. Cadaveric donors accounted for 43.7% (3280) of transplants. Graft rejection was the most common surgical complication (39.44%), and 60.49% of patients developed hypertension in the follow-up period.

Conclusion

Our study highlights the potential of kidney transplantation to improve the lives of ESKD patients in Africa. However, further research and infrastructure development are necessary to make this treatment more widespread and successful.

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References

  1. Murray JE (2011) Ronald Lee Herrick Memorial: June 15, 1931-December 27, 2010. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg 11:419. https://doi.org/10.1111/j.1600-6143.2011.03445.x

    Article  CAS  Google Scholar 

  2. Fabian J, Maher H, Bentley A et al (2016) Favourable outcomes for the first 10 years of kidney and pancreas transplantation at Wits Donald Gordon Medical Centre, Johannesburg, South Africa. S Afr Med J 106:172–176

    Article  PubMed  Google Scholar 

  3. Grassmann A, Gioberge S, Moeller S, Brown G (2005) ESRD patients in 2004: global overview of patient numbers, treatment modalities, and associated trends. Nephrol Dial Transplant 20:2587–2593. https://doi.org/10.1093/ndt/gfi159

    Article  PubMed  Google Scholar 

  4. Egbi OG, Okafor UH, Miebodei KE et al (2014) Prevalence and correlates of chronic kidney disease among civil servants in Bayelsa state, Nigeria. Niger J Clin Pract 17:602–607. https://doi.org/10.4103/1119-3077.141426

    Article  CAS  PubMed  Google Scholar 

  5. Arogundade FA, Sanusi AA, Hassan MO, Akinsola A (2011) The pattern, clinical characteristics and outcome of ESRD in Ile-Ife, Nigeria: is there a change in trend? Afr Health Sci 11:594–601

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Bamgboye EL (2003) Hemodialysis: management problems in developing countries, with Nigeria as a surrogate. Kidney Int 63:S93-95. https://doi.org/10.1046/j.1523-1755.63.s83.19.x

    Article  Google Scholar 

  7. Liyanage T, Ninomiya T, Jha V et al (2015) Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet Lond Engl 385:1975–1982. https://doi.org/10.1016/S0140-6736(14)61601-9

    Article  Google Scholar 

  8. Garcia GG, Harden P, Chapman J, For the World Kidney Day Steering Committee 2012 (2012) The global role of kidney transplantation. J Nephropathol 1:69–76. https://doi.org/10.5812/nephropathol.7448

    Article  PubMed  PubMed Central  Google Scholar 

  9. Farah SS, Alhaji MM, Ahmed D et al (2018) Barriers to kidney transplantation as a choice of renal replacement therapy. Transplant Proc 50:3165–3171. https://doi.org/10.1016/j.transproceed.2018.07.005

    Article  CAS  PubMed  Google Scholar 

  10. Ehtuish EF, Abouna GM, Shebani A-HA et al (2006) Kidney transplantation in Libya: a North African and Middle Eastern perspective. Exp Clin Transplant Off J Middle East Soc Organ Transplant 4:425–428

    Google Scholar 

  11. Eke FU, Ladapo TA, Okpere AN et al (2021) The current status of kidney transplantation in Nigerian children: still awaiting light at the end of the tunnel. Pediatr Nephrol Berl Ger 36:693–699. https://doi.org/10.1007/s00467-020-04753-7

    Article  Google Scholar 

  12. Mayosi BM, Lawn JE, van Niekerk A et al (2012) Health in South Africa: changes and challenges since 2009. The Lancet 380:2029–2043. https://doi.org/10.1016/S0140-6736(12)61814-5

    Article  Google Scholar 

  13. Gnan MM, Dahesh SMA, Abdel-Hamid I, Kamel R (2016) A comparative study between dialysis and kidney transplantation regarding the causes and survival period of the patients in Western area LIBYA. J Egypt Soc Parasitol 46:393–398

    PubMed  Google Scholar 

  14. Muturi A, Kotecha V, Kanyi S (2017) A retrospective study to assess the evaluation of living related kidney donors and their outcomes following nephrectomy at Kenyatta National Hospital. BMC Nephrol 18:171. https://doi.org/10.1186/s12882-017-0585-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Shigidi M, Ebrahim SA, Albashir SO (2021) An overview of the long-term follow-up of the adult post-kidney transplant recipients in sudan: a single-center experience. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab. https://doi.org/10.4103/1319-2442.338280

    Article  Google Scholar 

  16. Harzallah K, Abderrahim E, Chareffedine K et al (2008) Cancers after renal transplantation: multicenter experience. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab 19:825–830

    Google Scholar 

  17. Mashaly ME, Ismail MI, Lotfy EE et al (2016) Frequency of the original kidney disease and its effect on the outcome of kidney transplant in the Urology-Nephrology Center Mansoura University. Exp Clin Transplant Off J Middle East Soc Organ Transplant 14:157–165. https://doi.org/10.6002/ect.2015.0200

    Article  Google Scholar 

  18. Matter YE, Elhadedy MA, Abbas TM et al (2018) Impact of sex disparities on outcomes of living-donor kidney transplant in Egypt: data of 979 patients. Exp Clin Transplant Off J Middle East Soc Organ Transplant 16:133–137. https://doi.org/10.6002/ect.2016.0253

    Article  Google Scholar 

  19. Okafor UH (2016) Kidney transplant in Nigeria: a single centre experience. Pan Afr Med J 25:112. https://doi.org/10.11604/pamj.2016.25.112.7930

    Article  PubMed  PubMed Central  Google Scholar 

  20. Schamm M, Jugmohan B, Joseph C et al (2015) Kidney transplant outcomes following the introduction of hand-assisted laparoscopic living donor nephrectomy: a comparison of recipient groups. South Afr J Surg Suid-Afr Tydskr Vir Chir 53:63–66

    CAS  Google Scholar 

  21. Arogundade FA (2013) Kidney transplantation in a low-resource setting: Nigeria experience. Kidney Int Suppl 3:241–245. https://doi.org/10.1038/kisup.2013.23

    Article  Google Scholar 

  22. Sinada NSA, Naicker E, Tinarwo P, Bhimma R (2021) Kidney transplantation in children in KwaZulu-Natal. South Africa. Pediatr Transplant 25:e14016. https://doi.org/10.1111/petr.14016

    Article  PubMed  Google Scholar 

  23. Bardi R, Cherif M, Goucha R et al (2009) Kidney transplantation: Charles Nicolle Hospital experience. Transplant Proc 41:651–653. https://doi.org/10.1016/j.transproceed.2008.12.030

    Article  CAS  PubMed  Google Scholar 

  24. Siyoum M, Ahmed MM, Bekele M et al (2018) Live donor kidney transplant outcomes till february 2018 in the first kidney transplant center in Ethiopia. Transplantation 102:S558. https://doi.org/10.1097/01.tp.0000543421.42126.3e

    Article  Google Scholar 

  25. Ghoneim MA, Bakr MA, Hassan N, et al (2001) Live-donor renal transplantation at the Urology & Nephrology Center of Mansoura: 1976–1998. Clin Transpl, 167–178

  26. Ackoundou-N’Guessan C, Hoang AD, Ben Abdallah T et al (2015) Living kidney donor transplantation in a resource-limited country: the Ivory Coast experience. Transplant Proc 47:1580–1584. https://doi.org/10.1016/j.transproceed.2015.03.053

    Article  PubMed  Google Scholar 

  27. Usta A, Shawish T, Mishra A et al (2008) Living related kidney transplantation in Libya: a single center experience. Transplant Proc 40:3428–3433. https://doi.org/10.1016/j.transproceed.2008.06.063

    Article  CAS  PubMed  Google Scholar 

  28. Worku B (2020) Outcome of renal allograft recipients at Saint Paul's hospital millennium medical college, national kidney transplant center Addis Ababa, Ethiopia. Ethiop Med J

  29. Benziane A, Boutennoune S (2017) Pediatric kidney transplant: experience at an Algerian nephrology department. Exp Clin Transplant Off J Middle East Soc Organ Transplant 15:97–98. https://doi.org/10.6002/ect.mesot2016.O93

    Article  Google Scholar 

  30. Fadel FI, Bazaraa HM, Badawy H et al (2020) Pediatric kidney transplantation in Egypt: results of a 10-year single-center experience. Pediatr Transplant 24:e13724. https://doi.org/10.1111/petr.13724

    Article  PubMed  Google Scholar 

  31. Pitcher GJ, Beale PG, Bowley DM et al (2006) Pediatric renal transplantation in a South African teaching hospital: a 20-year perspective. Pediatr Transplant 10:441–448. https://doi.org/10.1111/j.1399-3046.2006.00489.x

    Article  CAS  PubMed  Google Scholar 

  32. Pontin AR, Botha J, Pascoe MD, Kahn D (1999) Preferential use of the right kidney for living-related transplantation. Transplant Proc 31:3130. https://doi.org/10.1016/s0041-1345(99)00748-4

    Article  CAS  PubMed  Google Scholar 

  33. Elsayed H, Sany D, Eldin EN et al (2012) Prevalence and association of post-renal transplant anemia. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab 23:461–466

    Google Scholar 

  34. Hajji S, Cheddadi K, Medkouri G et al (2010) Profile of living related kidney donors: a single center experience. Saudi J Kidney Dis Transplant Off Publ Saudi Cent Organ Transplant Saudi Arab 21:967–970

    CAS  Google Scholar 

  35. Muller E, Barday Z, Mendelson M, Kahn D (2012) Renal transplantation between HIV-positive donors and recipients justified. South Afr Med J Suid-Afr Tydskr Vir Geneeskd 102:497–498. https://doi.org/10.7196/samj.5754

    Article  Google Scholar 

  36. Bakr MA, Shehab El-Dein AB, Refaie AF et al (2020) Renal transplantation in Mansoura Egypt. Transplantation 104:1519–1521. https://doi.org/10.1097/TP.0000000000003268

    Article  PubMed  Google Scholar 

  37. Kahn D, McCurdie F, Pontin AR et al (1997) Results of renal transplantation in black patients in South Africa. Transplant Proc 29:3721. https://doi.org/10.1016/s0041-1345(97)01085-3

    Article  CAS  PubMed  Google Scholar 

  38. Banaga AS, Yousif ME, Elmusharaf K (2011) Risk factors of post renal transplant anaemia among Sudanese patients, a study in three renal transplant centres. BMC Nephrol 12:37. https://doi.org/10.1186/1471-2369-12-37

    Article  PubMed  PubMed Central  Google Scholar 

  39. Haddiya I, Radoui A, Benamar L et al (2012) Ten years of renal transplantation in a Moroccan hospital: results and constraints. Transplant Proc 44:2976–2981. https://doi.org/10.1016/j.transproceed.2012.02.038

    Article  CAS  PubMed  Google Scholar 

  40. Padayachee S, Adam A, Fabian J (2022) The impact of diabetes and hypertension on renal allograft survival- a single centre study. Curr Urol. https://doi.org/10.1097/CU9.0000000000000068.10.1097/CU9.0000000000000068

    Article  Google Scholar 

  41. Moosa MR, Grobbelaar C, Swanevelder SA, Edelstein CL (1992) The influence of race and the impact of socioeconomic and clinical factors on primary renal allograft survival. Transplant Proc 24:1754–1756

    CAS  PubMed  Google Scholar 

  42. Moosa MR (2019) The state of kidney transplantation in South Africa. South Afr Med J Suid-Afr Tydskr Vir Geneeskd 109:235–240. https://doi.org/10.7196/SAMJ.2019.v109i4.13548

    Article  CAS  Google Scholar 

  43. Abderrahim E, Zammouri A, Bacha MM et al (2017) Thirty years of experience at the first tunisian kidney transplant center. Exp Clin Transplant Off J Middle East Soc Organ Transplant 15:84–89. https://doi.org/10.6002/ect.mesot2016.O66

    Article  Google Scholar 

  44. Mudiayi D, Shojai S, Okpechi I et al (2022) Global estimates of capacity for kidney transplantation in world countries and regions. Transplantation 106:1113–1122. https://doi.org/10.1097/TP.0000000000003943

    Article  PubMed  PubMed Central  Google Scholar 

  45. Boima V, Agyabeng K, Ganu V et al (2020) Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana. PLoS ONE 15:e0244437. https://doi.org/10.1371/journal.pone.0244437

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Boima V, Amissah-Arthur MB, Yorke E et al (2021) Determinants of willingness to accept kidney transplantation among chronic kidney disease patients in Ghana. BMC Nephrol 22:129. https://doi.org/10.1186/s12882-021-02335-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Cecka JM (2000) Kidney transplantation from living unrelated donors. Annu Rev Med 51:393–406. https://doi.org/10.1146/annurev.med.51.1.393

    Article  CAS  PubMed  Google Scholar 

  48. Tang M, Li T, Liu H (2016) A Comparison of transplant outcomes in peritoneal and hemodialysis patients: a meta-analysis. Blood Purif 42:170–176. https://doi.org/10.1159/000446272

    Article  PubMed  Google Scholar 

  49. Tsoulfas G, Agorastou P, Ko DSC et al (2017) Laparoscopic vs open donor nephrectomy: Lessons learnt from single academic center experience. World J Nephrol 6:45–52. https://doi.org/10.5527/wjn.v6.i1.45

    Article  PubMed  PubMed Central  Google Scholar 

  50. Wang L, Zhu L, Xie X et al (2020) Long-term outcomes of laparoscopic versus open donor nephrectomy for kidney transplantation: a meta-analysis. Am J Transl Res 12:5993–6002

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Procurement O, Network (OPTN) T, Recipients (SRTR) SR of T (2012) OPTN/SRTR 2011 annual data report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation

  52. ANZDATA – Australia and New Zealand Dialysis and Transplant Registry. In: ANZDATA - Aust. N. Z. Dial. Transpl. Regist. - ANZDATA. https://www.anzdata.org.au/anzdata/. Accessed 23 Dec 2022

  53. Locke JE, Sawinski D, Reed RD et al (2018) Apolipoprotein L1 and chronic kidney disease risk in young potential living kidney donors. Ann Surg 267:1161–1168. https://doi.org/10.1097/SLA.0000000000002174

    Article  PubMed  Google Scholar 

  54. Afifi A, Karim MA (1999) Renal replacement therapy in Egypt: first annual report of the Egyptian Society of Nephrology, 1996. East Mediterr Health J Rev Sante Mediterr Orient Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit 5:1023–1029

    CAS  Google Scholar 

  55. Hassaballa Egyptian renal data system (ERDS) (2020) An annual report of end-stage kidney disease patients on regular hemodialysis. https://www.jesnt.eg.net/article.asp?issn=1110-9165;year=2022;volume=22;issue=1;spage=1;epage=28;aulast=Hassaballa. Accessed 29 Mar 2023

  56. Counil E, Cherni N, Kharrat M et al (2008) Trends of incident dialysis patients in Tunisia between 1992 and 2001. Am J Kidney Dis Off J Natl Kidney Found 51:463–470. https://doi.org/10.1053/j.ajkd.2007.10.032

    Article  Google Scholar 

  57. Davids MR, Eastwood JB, Selwood NH et al (2016) A renal registry for Africa: first steps. Clin Kidney J 9:162–167. https://doi.org/10.1093/ckj/sfv122

    Article  PubMed  Google Scholar 

  58. Davids MR, Marais N, Jacobs JC (2012) South African renal registry annual report 2012

  59. WHO (2023) Proposes global agenda on transplantation. https://www.who.int/news/item/30-03-2007-who-proposes-global-agenda-on-transplantation. Accessed 29 Mar 2023

  60. Southern African Transplantation Society (2023) https://sats.org.za/. Accessed 29 Mar 2023

  61. About US (2023) In: ESNT. https://esnt-online.com/about-us/. Accessed 29 Mar 2023

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Acknowledgements

We would like to acknowledge the support of the Surgery Interest Group of Africa in Supporting this paper.

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This paper did not require any funding.

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Author notes

  1. Samuel Olawale Davis, Abdulahi Zubair, Martin Igbokwe, Moses Abu, Chineme-Anyaeze Chiedozie, Quadri Sanni, and Damilola Jesuyajolu have been contributed equally to the paper.

Authors and Affiliations

  1. Urology, Surgery Interest Group of Africa, Lagos, Nigeria

    Samuel Olawale Davis, Abdulahi Zubair, Martin Igbokwe, Moses Abu, Chineme-Anyaeze Chiedozie, Quadri Sanni & Damilola Jesuyajolu

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  1. Samuel Olawale Davis
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Davis, S.O., Zubair, A., Igbokwe, M. et al. A Scoping Review of Kidney Transplantation in Africa: How Far have We Come?. World J Surg 47, 2113–2123 (2023). https://doi.org/10.1007/s00268-023-07042-0

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