Kidney transplant in low resources countries; 6 years of successes and challenges at Benjamin Mkapa Hospital, Tanzania

Abstract

BACKGROUND: Kidney transplantation (KT) is the optimal treatment for end-stage renal disease (ESRD), requiring multidisciplinary expertise, infrastructure, and reliable access to immunosuppression. This review examines the establishment and sustainability of a KT program at Benjamin Mkapa Hospital (BMH) in Tanzania since its inception in 2018 through a collaboration with Tokushukai Medical group (TMG) from Japan, highlighting successes, challenges, and long-term prospects. METHODOLOGY: We retrospectively reviewed the methods employed to establish the KT program and analysed data from 37 KT recipients transplanted between March 2018 and July 2024. Statistical analysis (SPSS version 27) yielded median and proportions, and Kaplan-Meier survival curves for patients' survival and graft survival. RESULTS: BMH successfully established a KT program with TMG collaboration, training 11 medical personnel. The main challenges encountered were shortage of trained staff, inconsistent supply of medical resources and immunosuppressive drugs, long turnaround times for outsourced histocompatibility tests, funding limitations, and a scarcity of kidney donors. Among 37 analysed recipients (70% male, median age 50 years with IQR: 39-56), hypertension (43%) and diabetes (32.5%) were the leading causes of ESRD. The majority of donors were blood-related (84%), with 16% being spouses. Graft survival rates at 1, 3, and 5 years were 94%, 90%, and 90%, respectively, while patient survival rate at 1,3 and 5 were 97%, 81%, and 81%, respectively. The overall estimated mortality rate was 37.3 (95%CI: 14.0-99.4) per 1000 person per years. CONCLUSION: BMH has successfully sustained a KT program led by a local team following training and mentorship from Japanese experts. The overall estimated mortality rate indicated favourable outcomes for kidney transplant recipients in this low-resource setting comparable to those in developed nations. The hospital's six-year experience demonstrates the feasibility of establishing and maintaining KT services in low-income countries.