243.4: Kidney transplantation in the maghreb countries: current situation, challenges and opportunities.

Abstract

Introduction: The Maghreb region, encompassing Libya, Tunisia, Algeria, Morocco, and Mauritania, is a geographical entity located in northwest Africa, covering an area of approximately 5 million km2 and hosting a population of around 100 million people who share common origins, histories, and cultures. Method: The data were gathered from the relevant authorities overseeing KT activity in each country, supplemented by a comprehensive literature review. Results: Except for Mauritania, which is set to initiate its transplant program soon, Kidney transplantation (KT) has been established for nearly 40 years. However, the activity, totaling no more than 450 KTs per year, remains markedly insufficient compared to demand. Indeed, a consistent increase in the number of dialysis patients, surpassing 80,000 individuals, with an average prevalence of end-stage renal disease of around 800 per million, is noted. Access to transplantation for children is even more limited, especially for those weighing less than 20 kg. KT activity in the Maghreb is governed by specific legal frameworks in each country, permitting transplantation exclusively from living donors (LD) in Algeria and Libya, and from LD and deceased donors (DD) in Morocco and Tunisia. In the latter two countries, the allocation of DD grafts is based on compatibility scores for listed patients, managed through a national waiting list system, encompassing approximately 400 patients in Morocco and 1700 in Tunisia. A national agency overseeing this activity exists only in Algeria, Mauritania, and Tunisia. Currently, 12 centers are performing KT in Algeria, 8 in Morocco, 6 in Tunisia, and only one in Libya. In all five countries, the costs of KT are fully covered by the state and/or medical insurance. Despite challenges in accessing activity reports in these countries, various publications highlight favorable outcomes in terms of graft and patient survival, both short and long-term, comparable to those reported in developed countries. However, despite progress made in the Maghreb countries, KT activity remains fragile, as demonstrated by the COVID-19 pandemic, leading to nearly complete cessation and difficulties in resuming this activity. This fragility is inherent in economic challenges, political instability, insufficient support for public health policies, and inadequate public adherence to organ donation. Conclusion: The development of KT in the Maghreb necessitates multidimensional action, prioritizing it as a public service mission, expanding graft sources (extended criteria donors, kidney paired donation, donors after circulatory death…), enhancing technical capabilities (histocompatibility, pharmacology, renal allograft pathology, interventional radiology…), establishing academic training programs in organ transplantation in collaboration with universities and paramedical institutions, reinforcing organ donation culture in society through new communication channels, and diversifying funding sources.