Contemporary outcomes of the pediatric kidney transplant program in Johannesburg, South Africa, between 2004 and 2017: Better or not—And which way forward?

Abstract

Background Outcomes for the pediatric kidney transplant program in Johannesburg (1984‐2003) were found to be suboptimal. In this study, we compared (a) early (era 1:1984‐2003) to contemporary (era 2:2004‐2017) outcomes and (b) compared contemporary outcomes between the public and private sector hospitals in our program. Methods We conducted a retrospective record review of all pediatric (<18 years) KA transplants performed in our kidney transplant program at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC) from 2004 to 2017. We collected the following data per site: number of recipients, transplants performed, mean follow‐up time, and grafts lost; per recipient: age at time of transplant, sex, self‐reported population group; transplant history; donor type; etiology of ESKD; recipient and graft survival. Outcomes for era 1 were based on data published on our kidney transplant program, based at CMJAH. Results At CMJAH (public sector), there was no improvement in recipient and graft survival over time. In the contemporary analysis, 1‐, 5‐, and 10‐year recipient survival, as % (95% CI) was 93 (84‐97); 76 (64‐84); 59 (44‐70) for CMJAH, and 98 (90‐99); 95 (86‐99); 82 (54‐94) for WDGMC (private sector). Similarly, 1‐, 5‐ and 10‐year graft survival was 75 (63‐84); 55 (42‐66); 36 (24‐49) for CMJAH, and 96 (87‐99); 84 (73‐91); 64 (48‐76) at WDGMC. Conclusion Contemporary outcomes for the pediatric kidney transplant program at WDGMC are comparable to outcomes achieved in middle‐ and high‐income settings. However, outcomes at CMJAH are suboptimal, reflecting numerous health system, infrastructural and human resource challenges.

Addressing the Ethical Challenges of Providing Kidney Failure Care for Children: A Global Stance

“…Although short term graft outcomes are compatible with HIC, allograft survival at 5 years were consistently <80% and much lower at 10 years, in spite of the predominance of living donor transplants ( 81 ). The most frequently cited causes for graft loss were chronic rejection and infections ( 75 , 78 , 104 ). Infrastructure for immunosuppression drug level monitoring, histopathology and viral load surveillance is underdeveloped in most LMICs.…”