Outcomes of patients returning after receiving live donor kidney transplantation abroad at Saint Paul Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia,2015- 2022

Abstract

ABSTRACT Introduction: Kidney transplant is the optimal management for patients with ESRD. The provision of transplant activity is limited in sub-Saharan African countries, including Ethiopia. The long waiting list at Saint Paul makes most patients seek kidney transplants abroad but their clinical outcomes are not known. Therefore, the information obtained from this study will allow physicians to better understand their post-transplant outcomes and provide care accordingly. Objective: The study aimed to assess the outcomes of patients returning after receiving live donor kidney transplantation abroad at Saint Paul Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, from September 1st 2015 to December 31st 2022. Methodology: A retrospective chart review was conducted from February 1st to April 30th, 2023 among a total of 74 live donor kidney transplant recipients from abroad and were on follow up at SPHMMC from September 1st 2015 to December 31st 2022 for at least one year. Data was summarized using frequency with proportion, mean (standard deviation), median (interquartile range), and graphs. To identify the presence of significant difference in the rate of complication between different groups, chi-square test/Fisher's exact test, independent t-test/ Mann-Whitney U test were used where p-value of <0.05 indicates a statistically significant difference. Results: The mean age of the participants was 34.9 ± 11.3 years and 54/74 were males. The mean eGFR at 1 week, 3 months, 6 months, 1 year, 2 years, and 3 years was 100.9 ± 27.5, 90.9 ± 22.2, 91.7 ± 21.6, 93.2 ± 24.7, and 93.9 ± 23.9 ml/min/1.73 m2, respectively. In the 3rd year, the median eGFR was 109.6 (IQR, 82.5-129.4) ml/min/1.73 m2. Stage 3a CKD was diagnosed in 4/74, 1/23, and 1/5 cases in the 1st, 2nd, and 3rd year of follow up. Stage 3b CKD and stage 2 CKD were diagnosed in 1/74 and 2/74 cases in the 1st year of follow-up, respectively. The rate of posttransplant complication was 35/74 (47.3%, 95%CI= 36.4-59.6%) with the most frequent complication being infection in 29/58 and mortality rate was 1/74 (1.4%). The rate of complication didn’t show a statistically significant difference based on any of the studied patient characteristics. Conclusion: The post-transplant outcome of live donor kidney transplant recipients abroad who were followed for an average of 24.7 ± 13.2 months showed that kidney function can remain stable for most patients and only few progressed to stage 2 and 3 CKD, a considerable proportion has developed one or more complication(s) and mortality rate was very low. Recommendation: The findings of the study provide an insight to clinicians to understand the post-transplant complications of patients who travel for transplantation, what to expect and be prepared accordingly and also serves as a baseline for further studies. Key words: Kidney Transplant, Post-transplant complications, post-transplant mortality, Retrospective chart review, Ethiopia