Outcomes of Kidney Allograft Rejection: A Case Series from the Only Kidney Transplant Center in Ethiopia

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Outcomes of Kidney Allograft Rejection: A Case Series from the Only Kidney Transplant Center in Ethiopia

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Co-author 1

Seifemichael Getachew getseyfem@gmail.com SPHMMC Nephrology Addis Ababab Ethiopia *

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Introduction

Kidney transplantation in Ethiopia remains limited, with St. Paul’s Hospital Millennium Medical College (SPHMMC) serving as the nation’s only public transplant center. Graft rejection is a major cause of allograft dysfunction globally, yet little is known about its presentation and outcomes in low-resource settings. This study describes the clinical characteristics, management, and short-term outcomes of patients treated for graft rejection at SPHMMC.

Methods

A retrospective case series was conducted among kidney transplant recipients with clinical and/or biopsy-proven graft rejection managed between January 2023 and October 2025 at SPHMMC. Data were collected on donor relationship, induction therapy, type of rejection, anti-rejection management, and renal outcomes. Descriptive analyses were performed to summarize key findings.

Results

Eight patients were identified. Donors included parents (3), siblings (3), and spouses (2). Induction regimens included antithymocyte globulin (4), basiliximab (1), and not documented (3). Types of rejection comprised antibody-mediated (6), and mixed (2). Biopsy was done only for four patients. The other four are diagnosed clinically. All patients received high-dose corticosteroids; two received ATG, and seven received rituximab and one received IVIG. Plasmapheresis and donor-specific antibody (DSA) testing were unavailable. Seven patients (87.5%) experienced progressive graft dysfunction despite therapy, and one showed partial improvement without full recovery. 75% of the patients subsequently developed graft failure. Limited access to timely biopsy, DSA testing, and advanced therapies contributed to poor outcomes.

Conclusion

In this first reported Ethiopian series, kidney graft rejection outcomes were suboptimal due to diagnostic and therapeutic constraints. Strengthening local immunologic testing, establishing plasmapheresis capacity, and standardizing treatment protocols are critical to improving graft survival. These findings highlight the urgent need for investment in transplant infrastructure and research in low-resource settings.

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