One year kidney allograft survival in sub-Saharan Africa: systematic review and meta-analysis

Abstract

Background Kidney transplantation offers superior survival and quality-of-life benefits compared with dialysis; however, access in sub-Saharan Africa remains limited, and evidence on one-year allograft survival is fragmented and largely derived from small, single-center studies. This systematic review and meta-analysis aimed to estimate the pooled one-year kidney allograft survival rate in SSA. Objective To estimate the pooled one-year kidney allograft survival rate in SSA. Methods Studies were identified through systematic searches of MEDLINE, Scopus, Google Scholar, the Transplantation Library, and African Journals Online. A random-effects model with the DerSimonian–Laird estimator was used to estimate the pooled effect size. Statistical heterogeneity was assessed using the I² statistic, and publication bias was evaluated using Egger’s and Begg’s regression tests. Meta-regression analyses were conducted to explore potential sources of heterogeneity. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD420251275787). Result Fifteen studies comprising 3,595 renal transplant recipients met the inclusion criteria. The pooled one-year kidney allograft survival was 88.01% (95% CI: 81.81%–94.21%). Substantial between-study heterogeneity was observed (I² = 96.07%, p < 0.001). In subgroup analyses, one-year allograft survival was higher among living-donor recipients, with a pooled estimate of 92.02% (95% CI: 88.23%–95.81%). Conclusion This systematic review and meta-analysis demonstrate that one-year kidney allograft survival in sub-Saharan Africa is moderate but remains lower than rates reported in high-income countries. Survival was notably better among living-donor recipients. This suggests a need to strengthen kidney transplant programs in sub Saharan Africa