Establishing kidney transplantation in a low-income country: a case in Tanzania

Abstract

Abstract Background Sub-Saharan African countries, including Tanzania, have a high burden of chronic kidney diseases (CKDs) and limited capacity for the provision of services. Tanzania and other countries in the region have made significant improvements in the provision of services for patients with CKD, including hemodialysis. Few countries are offering kidney transplantation services, which is the definitive treatment for patients with CKD and kidney failure. This study was conducted to review the steps taken by Muhimbili National Hospital (MNH) to establish a kidney transplantation service in Tanzania. Methods This study was based on the review of the activities that were undertaken to establish kidney transplantation services at Muhimbili National Hospital in Dar es Salaam, Tanzania. It was conducted by reviewing key documents developed for kidney transplantation and interviewing key personnel who were involved in the process. Results Kidney transplantation services at MNH were established in November 2017; several steps were taken in the preparatory phase including training of personnel, infrastructural modifications, and procurement of equipment and supplies. Capacity building was achieved through international collaboration with several international and local institutions, including three Hospitals in India. The transplant team, which included nephrologists, urologists, anesthesiologists, radiologists, nurses, laboratory technicians, a transplant coordinator, and a lawyer, underwent short-term training at BLK Hospital in India. Initial transplant procedures were carried out with support from visiting personnel from BLK, Sakra, and Seifee hospitals. In total, 72 transplant surgeries were conducted, of which 39 (54.2%) were performed with visiting teams and 31 (45.8%) by the local team independently. Of the initial 39 recipients, 56.4% were males and 43.5% were aged above 46 years. About half of the donors were brothers/sisters, and 43.5% had human leukocytic antigen haplomatch. Induction immunosuppression included basiliximab in the majority (64.1%) of recipients, and all recipients received prednisolone, tacrolimus, and mycophenolate mofetil/myfortic. Conclusions Establishing kidney transplantation in lower-income countries, such as Tanzania, is feasible; however, it requires dedicated efforts. Collaboration with local and international institutions provided an enabling environment for the transfer of skills and access to necessary supportive services.

Keywords

• Nephrology in Tanzania
• Nephrology training
• Nephrology in sub-Saharan Africa