Introduction: Establishing a living donor kidney transplant program in a limited resource setting while upholding internationally accepted ethical and regulatory requirements and aiming for outstanding outcomes is a challenging task. To reduce medical referrals abroad and make surgical care more accessible to patients from Rwanda and the region, King Faisal Hospital Rwanda (KFH) established the country’s first living donor kidney transplant program, which launched in May 2023. We describe the socio-demographic features and initial outcomes of living donor kidney transplant recipients in our new program.
Methods: A retrospective analysis was conducted across kidney transplant recipients, including their demographics, clinical characteristics, and initial surgical and clinical outcomes. The surgical techniques and kidney transplant evaluation, management, and follow-up are similar to those used at reputable transplant hospitals worldwide.
Results: Twenty living donor kidney transplants were performed over nine months, from May 2023 through January 2024. The mean age of the recipients was 44.8 years, with 45% of the recipients being between 46 and 60 years, and 75% being male. Seventeen transplants were performed between related donors (parents and siblings), and only three donations were from unrelated donors. The primary diagnoses of kidney failure were diabetic nephropathy (35%), hypertension (35%), and chronic glomerulonephritis (25%). There was one allograft biopsy-proven cellular mediated rejection. Two recipients developed lymphocele during the first three postoperative months. Among the twenty recipients, new onset diabetes occurred in two recipients post-transplantation. Only one recipient required hospital readmission post-transplant because of ureteric stenosis. The mean serum creatinine at 1 month, 3 months, 6 months, and 9 months was 118.3, 94.3, 86.4, and 91.8 micromol/L respectively.
Conclusion: Rwanda’s living donor transplant program emphasizes sustainable and equitable access to care. Furthermore, ongoing transplant surgical and medical education emphasizes in-country training within Rwanda with support through academic partnerships. Program structure, protocols, and results are comparable to those achieved in Europe and North America. To come to a more accurate conclusion, further studies with a comparatively larger cohort and a longer follow-up period will be needed.