ONE YEAR OUTCOMES OF KIDNEY TRANSPLANT RECIPIENTS IN ZAMBIA - SUBSAHARAN AFRICA

Introduction:

Kidney transplantation is an effective form of kidney replacement therapy with the best outcomes and quality of life. However, despite Sub-Saharan Africa having a large share of the burden of CKD, kidney transplantation programs are essentially nonexistent.

Zambia, a country in sub-Saharan Africa, with a population of 19,610,759 has a prevalence of chronic kidney disease ranging between 20 and 30%. With the launch of its transplant program in 2018, 21 patients had been documented to have received kidneys from living-related donors as of 2022.

There is a huge burden of chronic kidney disease in Zambia with at least 1 of 5 people having some sort of kidney dysfunction. Though the majority of patients are on long-term dialysis, morbidity and mortality remain high.  There is a paucity of data about kidney transplantation across sub-Saharan Africa. In the first year of the inception of Libya’s national transplant program, the allograft survival rate at a median of 16 months (10 – 22) was found to be 98%. In Nigeria, the 1-year year allograft and patient survival was 83.2% and 90.2% respectively from 143 patients undergoing transplantation between 2000 and 2010. In South Africa, at Donald Gordon Medical Centre Johannesburg, with a transplant unit since 2004, the 10-year survival of the recipient and allograft was 80.4% and 66.8% respectively. The study aimed to determine the one-year allograft and patient survival in kidney transplant patients in Zambia.

Methods:

This was a retrospective cohort study recruiting kidney transplant patients from January 2018 and 2024 receiving care at the University Teaching Hospital, Lusaka. A review of patient medical records was done to determine distribution, measures of central tendency and variability. Kaplan Meier graphs were generated using SPSS v27.

Results:

The total sample size was 20. The median age was 45 years with a range of 37. Sex was unevenly distributed with 60% of our sample being male. The median duration of dialysis prior to transplant was 25 months with patients with underlying hypertension and diabetes being 95% and 15% respectively. Of the sampled population, 10% and 5% had well-controlled HIV and hepatitis B respectively.  Regarding immunosuppression, 65% of the patients were on a combination of tacrolimus, mycofenolate, and prednisolone, followed by azathioprine, mycofenolate, and prednisolone, then everolimus with mycofenolate and prednisolone, and cyclosporine with leflunomide and prednisolone.

The survival estimate of patient and allograft survival were 0.83 and 0.94 respectively as shown in figure 1 and 2.

Conclusions:

The one-year allograft and patient survival estimate were 0.94 and 0.84 respectively which was similar to other countries in the region. Acute rejection was the only cause of allograft failure, with sepsis being the only cause of mortality in our sampled population during the study period. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.