Introduction:
Kidney transplantation is an effective form of renal replacement therapy. The availability of kidney transplantation in sub-Saharan Africa is limited with hemodialysis being the most common form of kidney replacement therapy. With a prevalence of 30%, chronic kidney disease poses significant risk of morbidity and mortality in Zambia. With kidney transplantation being the best form of kidney replacement therapy in the world, Zambia launched its transplant program in 2018, however, no baseline date on the complications of transplantation have been documented either in the country nor the region. In a report by kidney international, the patient and allograft survival of transplant patients in Zambia is lower than that in the western world. A similar picture of survival in the region is also noted. Globally, the most common cause of graft losses in the first year of transplant is attributed to vascular complications, acute rejection, infections and glomerulonephritis at. The primary cause of death in a functional allograft within one year was heart disease, infection and cancer at 31%, 31% and 29% respectively. Zambia launched its kidney transplant program in 2018. As of 2024, 20 people were being followed up in the nephrology department of the university teaching hospital where the transplant program is housed. This study aimed to determine complications of recipients of kidney transplantation surgery in Zambia.
Methods:
This was a retrospective descriptional cross sectional study were we reviewed our database of kidney transplant patients between 2018 and 2024. Distribution, measures of central tendency and variability were determined using spss ver27.
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. Complications reported in the first year of transplant in our sampled population in their order of prevalence were infection (40%), NODAT (35%), tacrolimus toxicity (20%), sepsis (15%), acute rejection (15%), and Catheter leak (5%).
Conclusions:
In our setup, the commonest kidney transplant complications included infection, new onset diabetes after transplantation, and tacrolimus toxicity. In our cohort, all three mortalities that were recorded during the study period were attributed to sepsis. None of our patients died from cardiovascular causes as is usually seen in other countries. Given the high burden of sepsis and NODAT in post-kidney transplantation, investment in proper infection prevention is key for both patients and caregivers of patients receiving kidney transplantation surgery.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.