The current status of kidney transplantation in Nigerian children: still awaiting light at the end of the tunnel

Eke, Felicia U.; Ladapo, Taiwo Augustina; Okpere, AN; Olatise, Olalekan; Anochie, Ifeoma; Uchenwa, Tochi; Okafor, HU; Ibitoye, Paul Kehinde; Ononiwu, Uchenna; Ademola, Adebowale D.; Akuse, Rosamund; Oniyangi, Seyi

doi:10.1007/s00467-020-04753-7

Cited by 14 publications

(8 citation statements)

References 17 publications

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“…Pediatric kidney transplant centers in LMICs successfully perform transplants, with excellent short term graft survival but access to transplant and transplant centers remains limited (75)(76)(77)(78)(79). There are insufficient pediatric transplant centers and transplant rates for Sub-Saharan Africa and South East Asia remain absent or dismally low (80)(81)(82).…”

Section: Inequities In Access To Kidney Transplantmentioning

confidence: 99%

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

Pais

Wightman

2022

Front. Pediatr.

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Children with kidney failure require kidney replacement therapy (KRT), namely maintenance dialysis and kidney transplant. Adequate kidney failure care consists of KRT or conservative treatment with palliative care. In the context of kidney failure, children depend on parents who are their surrogate decision-makers, and the pediatric nephrology team for taking decisions about KRT or conservative care. In this paper, we discuss the ethical challenges that arise relating to such decision-making, from a global perspective, using the framework of pediatric bioethics. While many ethical dilemmas in the care of children with KRT are universal, the most significant ethical dilemma is the inequitable access to KRT in low & middle income countries (LMICs) where rates of morbidity and mortality depend on the family's ability to pay. Children with kidney failure in LMICs have inadequate access to maintenance dialysis, timely kidney transplant and palliative care compared to their counterparts in high income countries. Using case vignettes, we highlight how these disparities place severe burdens on caregivers, resulting in difficult decision-making, and lead to moral distress among pediatric nephrologists. We conclude with key action points to change this status-quo, the most important being advocacy by the global pediatric nephrology community for better access to affordable kidney failure care for children.

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Section: Inequities In Access To Kidney Transplantmentioning

confidence: 99%

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

Pais

Wightman

2022

Front. Pediatr.

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“…46 The situation is similarly concerning elsewhere in Africa where accessibility is even worse. 9,11 Social change is urgently required to improve access to and outcomes for all who could benefit. The long-term expectation would be that the right to health of people with KF is progressively realized over time in South Africa, that everyone will have access to chronic dialysis even if not considered transplantable, and that rationing will no longer be required.…”

Section: Discussionmentioning

confidence: 99%

“…Significant disparities exist in access to kidney transplantation for children, both between high‐income (HIC) and low‐ and middle‐income countries (LMIC), and even within countries themselves 6,7 . Reasons are multifactorial including variable access to pediatric nephrology services, timing of initiation of the transplant evaluation processes, country income status, policies on deceased donation, and societal attitudes towards transplantation within countries 8–11 . The prevalent low socioeconomic status of most families in LMIC is another key factor causing disparity in accessibility to KRT, given the high rates of poverty and unemployment, this is more pronounced in South Africa, partly due to the legacy of apartheid 12,13 …”

Section: Introductionmentioning

confidence: 99%

“…6,7 Reasons are multifactorial including variable access to pediatric nephrology services, timing of initiation of the transplant evaluation processes, country income status, policies on deceased donation, and societal attitudes towards transplantation within countries. [8][9][10][11] The prevalent low socioeconomic status of most families in LMIC is another key factor causing disparity in accessibility to KRT, given the high rates of poverty and unemployment, this is more pronounced in South Africa, partly due to the legacy of apartheid. 12,13 Living-related donation (LRD) from family members is the most attractive transplant option, especially in children.…”

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confidence: 99%

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Evaluation of the implementation of a “Pediatric Feasibility Assessment for Transplantation” tool in children and adolescents at Red Cross War Memorial Children's Hospital, Cape Town, South Africa

Adetunji,

Gajjar,

Luyckx

et al. 2024

Pediatric Transplantation

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BackgroundKidney transplantation remains the treatment of choice for children with kidney failure (KF). In South Africa, kidney replacement therapy (KRT) is restricted to children eligible for transplantation. This study reports on the implementation of the Paediatric Feasibility Assessment for Transplantation (pFAT) tool, a psychosocial risk score developed in South Africa to support transparent transplant eligibility assessment in a low‐resource setting.MethodsSingle‐center retrospective descriptive analysis of children assessed for KRT using pFAT tool from 2015 to 2021.ResultsUsing the pFAT form, 88 children (median [range] age 12.0 [1.1 to 19.0] years) were assessed for KRT. Thirty (34.1%) children were not listed for KRT, scoring poorly in all domains, and were referred for supportive palliative care. Fourteen of these 30 children (46.7%) died, with a median survival of 6 months without dialysis. Nine children were reassessed and two were subsequently listed. Residing >300 km from the hospital (p = .009) and having adherence concerns (p = .003) were independently associated with nonlisting. Of the 58 (65.9%) children listed for KRT, 40 (69.0%) were transplanted. One‐year patient and graft survival were 97.2% and 88.6%, respectively. Only one of the four grafts lost at 1‐year posttransplant was attributed to psychosocial issues.ConclusionsShort‐term outcomes among children listed using the pFAT form are good. Among those nonlisted, the pFAT highlights specific psychosocial/socioeconomic barriers, over which most children themselves have no power to change, which should be systemically addressed to permit eligibility of more children and save lives.

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“…For instance, in Libya, which has a population of approximately 5 million people, around 2500 patients relied on dialysis due to a lack of transplantation options [10]. The limited availability of kidney transplantation options ultimately contributes to a high mortality rate among ESRD patients, with an estimated 80% of individuals dying within a few weeks of diagnosis [11]. In South Africa, kidney disease has emerged as a leading cause of mortality, accounting for a staggering 1000 deaths per million population [12].…”

Section: Introductionmentioning

confidence: 99%

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

Davis,

Zubair,

Igbokwe

et al. 2023

World j. surg.

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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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The current status of kidney transplantation in Nigerian children: still awaiting light at the end of the tunnel

Cited by 14 publications

References 17 publications

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

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

Evaluation of the implementation of a “Pediatric Feasibility Assessment for Transplantation” tool in children and adolescents at Red Cross War Memorial Children's Hospital, Cape Town, South Africa

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

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