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.
Keywords: Kidney transplant, Low-resource countries, Success, Challenges, Benjamin Mkapa Hospital
Background
The prevalence of chronic kidney disease (CKD) is alarming worldwide because of the increase in the incidence of non-communicable diseases (NCDs). Recent data show that the prevalence of CKD is 10–16% of the population worldwide [1–4]. The prevalence is greater in low-income countries because of the double burden of communicable and NCDs [5]. In Tanzania, few studies have shown that the prevalence of CKD ranges from 7 to 13.6% in three community-based studies [6–8] and 24.7% in hospital-based studies of patients with diabetes [9].
The kidney transplant (KT) program is a specialized program requiring a highly skilled multidisciplinary team with appropriate training on transplantation, high-tech equipment and specialized medicine. The establishment and sustainability of transplant programs require careful planning with the national government and institutional support.
In Africa, KT is performed in few countries, and programs in those countries face a number of challenges, including wide socioeconomic disparities, a shortage of skilled medical personnel, a lack of facilities for the provision of KT services, a high risk of infection after kidney transplant due to an infectious disease burden, insecure access to and monitoring of immunosuppression, and a lack of legislation on organ donation and brain death in many countries [10]. A study undertaken at Muhimbili National Hospital (MNH) in Tanzania highlighted challenges facing the KT program, particularly the unreliable medical supply chain and the lack of cross-matching reagents. There was also a lack of registration for immunosuppressive drugs and graft preservation fluids. Even when available, these materials often have a limited shelf life, hence hindering the ability to maintain sufficient supplies. Further challenges included limited funding for kidney transplantation procedures, particularly for patients who did not subscribe to the National Health Insurance Fund, and inadequate public knowledge and misinformation about transplant procedures, leading some donors to decline consent [11].
Despite these challenges, KT continues to be the best therapy recommended for ESRD patients. Evidence from numerous studies in both higher- and lower-income countries indicates favourable outcomes for KT services. One study from a higher-income country, Mexico, reported graft survival rates of 95.4%, 91.7%, 88.2%, 86.6%, and 85.5% at 1, 3, 5, 7, and 10 years, respectively. Patient survival rates in the same study were 92.7%, 90.4%, 89.7%, 89.4%, and 88.9% at 1, 3, 5, 7, and 10 years, respectively [12].
In middle-income African countries, such as South Africa, graft survival was reported to be 89.4% at 1 year and 80.0% at 5 years. Patient survival in these settings was 90.4% at 1 year and 83.1% at 5 years [13].
In Nigeria, a country with a general population income similar to that of many other African countries, the reported graft survival rates were 95.3% and 67.6%, and patient survival rates were 97.7% and 82.4% at one and three years, respectively. The reported death rate in this context was 29.8% [14].
In Tanzania, a review study of the KT programme at MNH in Dar es Salaam reported that 37 individuals (94.9%) had good graft function, 1 recipient returned to dialysis, and 1 died at one-month post KT. Another cohort study of 68 individuals at the same center reported one-year patient and graft survival rates of 91.2% and 96.7%, respectively, with 5 deaths [11, 15].
Setting KT program at Benjamin Mkapa Hospital
Benjamin Mkapa Hospital (BMH) is a tertiary zonal referral and teaching Hospital of the University of Dodoma (UDOM) owned by the government of Tanzania located in Dodoma, which is the capital city of Tanzania (Fig. 1).
Fig. 1.
Map of the United Republic of Tanzania showing all regions, including Dodoma region where BMH is located, and its bordering countries [16]
In 2016, the hospital and UDOM, in collaboration with the TMG, aimed to establish a KT program. The establishment of the KT program at BMH was a direct outcome of a well-defined partnership with TMG, a Japanese non-profit, non-governmental organization founded by Torao Tokuda, which had signed a Memorandum of Understanding (MOU) in 2003 with the Government of Tanzania, under the Ministry of Health, to enhance national healthcare delivery.
As part of this collaborative partnership, TMG donated 10 hemodialysis machines to UDOM in 2013, significantly contributing to the foundational infrastructure for renal care in the region. In 2016, a team of medical experts from Shonan Kamakura General Hospital, a TMG institution, conducted a follow-up site visit to UDOM’s hemodialysis unit. In the discussions regarding the progress of the hemodialysis service, the university management requested the delegation leader to consider expanding the service to include kidney transplantation. Given the absence of domestic kidney transplant capabilities, all patients with ESRD requiring transplantation faced referral abroad at a substantial cost. BMH, being the teaching hospital of UDOM was identified as the potential center for establishing this much-needed KT service. The Japanese team accepted the request, upon a feasibility study to assess the requirements for establishing a successful KT program.
Situational analysis of the KT service
The initial assessment demonstrated that BMH had already some good existing infrastructure, such as a CT scan, MRI, and a laboratory equipped with machines that enable the performance of some tests needed to evaluate individuals for KT. Furthermore, there were two operating rooms installed with modern operating towers and beds. However, there were unavailability of modern anaesthesia machines, Modern ICU equipment, KT consumables, special drugs particularly immunosuppressive drugs, laboratory machine and reagents for drugs monitoring. Another identified critical gap was the insufficient number of trained personnel specializing in KT including transplant surgeons, general surgeons, nephrologists, pharmacists, pathologists, and immunologists.
In 2016, the number of individuals with ESRD on hemodialysis in Tanzania was estimated to exceed 1,000, with approximately 350 considered potential candidates for KT. This situation necessitated costly overseas referrals, accompanied by significant logistical challenges. The Government of Tanzania referred to CKD patients abroad for transplantation, incurring an estimated annual expenditure of USD 10 million.
Planning and designing of the program
The Hospital and TMG signed a four-year Memorandum of Understanding (MOU) to train the identified team and supervise the program until the local team had the capacity to perform kidney transplants independently. The hospital, through the Ministry of Health, set up funds for training, infrastructure improvement, the purchase of various materials, and project implementation as follows.
Infrastructure
The initiation of its KT program prompted BMH to undertake significant infrastructure improvements. These upgrades were vital in order to meet the specific requirements for transplant procedures. The focus was put to ensure that the operating room, ICU, laboratory and pharmacy have all equipment and materials essential for KT service.
Therefore, BMH and UDOM jointly procured critical equipment, consumables, and pharmaceuticals. In the operating room, which already had operating tower and bed, they purchased Bookwalter retractors, KT surgical sets, initial specialized sutures for vessel anastomosis, and ureteric stents. The ICU was equipped with ventilators, patient monitors, and necessary medical supplies. Moreover, purchase of immunosuppressive and other essential drugs Due to limited local availability, most of these materials were sourced internationally. Furthermore, the TMG team contributed additional items.
To enhance diagnostic capabilities, necessary laboratory machines and reagents were procured. However, a significant obstacle was the inability to perform histocompatibility testing such as Human Leukocyte Antigen (HLA) typing, complement-dependent cytotoxicity (CDC) cross matching, donor-specific antibody (DSA) assessment, and panel reactive antibodies (PRA) assessment, which are crucial tests for KT program. This challenge was addressed by outsourcing these tests other laboratory.
Lancet Laboratories, a South African-based laboratory with operational branches in Tanzania demonstrating the requisite capacity, was identified as a primary partner for these specialized laboratory tests. Subsequently, a collaboration was also established with Metropolis Healthcare, a laboratory based in India, to serve as a secondary provider. Therefore, HLA typing, DSA testing, CDC cross matching, and PRA screening were outsourced to these external laboratories after having MOU with them. The specific platforms used by Lancet Laboratories and Metropolis Healthcare for HLA and DSA testing were not directly managed by our local team. However, these are established reference laboratories adhering to international quality standards for histocompatibility testing.
Staff training
To initiate the kidney transplant (KT) program, a multidisciplinary team of experts from Benjamin Mkapa Hospital (BMH) and the University of Dodoma (UDOM) was selected for comprehensive practical training in Japan. This training was structured into three phases, with team members traveling in batches to Tokyo Women’s Medical University and Shonan Kamakura General Hospital.
Three surgeons (two general surgeons and one urologist) underwent a two-year preparatory hands-on training program in kidney transplantation at Tokyo Women’s Medical University and Shonan Kamakura General Hospital. This involved three separate one-month visits to Japan for each surgeon. During these intensive periods, they actively participated in kidney transplant procedures, initially as surgical assistants to experienced surgeons to acquire essential techniques. Progressively, they began performing vascular anastomosis and other surgical procedures under direct supervision to ensure skill acquisition. They did not function as primary surgeons during this training phase.
The number of cases observed and assisted varied based on the clinical workload and available training opportunities, typically ranging from 4 to 6 kidney transplants per week at Tokyo Women’s Medical University and 4 kidney transplants per week at Shonan Kamakura General Hospital. The training enabled surgeons to gain skills of vascular anastomosis and implantation of kidney while the urologist concentrated mainly in harvesting the kidney and ureteric anastomosis. Notably, both institutions routinely perform laparoscopic donor nephrectomy.
Subsequently, other essential team members underwent training in Japan alongside the surgeons. This group included two nephrologists, three theatre nurses, one critical care nurse, one laboratory technologist, and one pharmacist. These experts received focused training on critical aspects of kidney transplantation, including essential pre-transplant evaluation tests for both recipients and donors, intraoperative care, the administration and management of immunosuppressive drugs, therapeutic drug monitoring of tacrolimus levels, and the identification and management of acute and chronic graft rejection.
Over a three-year period (2018–2020), a team of expert surgeons from Japan consisting of 2 transplant surgeons and anaesthesiologists, 2 transplant physicians and a laboratory technologist expert in KT provided continuous onsite mentorship to the local team (surgeons and physicians), during which time 11 patients with end-stage renal disease (ESRD) underwent kidney transplantation. Moreover, this collaborative relationship with the TMG has been maintained, with experienced surgeons from Shonan Kamakura General Hospital making regular physical visits to BMH for continued training and providing consultative advice by videoconferencing and other digital platforms to discuss complex cases.
In 2019, Shonan Kamakura General Hospital subsequently conducted a further training session for one surgeon and one physician who had been previously trained. The purpose of this training was to expose them to advanced surgical techniques and updated clinical practices. This opportunity enabled the surgeon to participate in KT procedures for more complex cases, such as multiple vessel kidney transplantation, recipients with sclerotic vessels and also exposed in techniques of vascular access construction such as arteriovenous fistula (AVF) and the physician to ABO-incompatible transplantation.
To facilitate the KT project, the hospital maintained an ongoing training program for personnel across all cadres. In 2023, two surgeons underwent a year of specialized training in KT abroad, one in Israel and one in India. One surgeon completed their training and returned in September 2024 and has joined the transplant team. Furthermore, transplant surgeons have been engaging in skills and knowledge exchange for difficult cases with surgeons from MNH, which also provides KT services.
Provision of service
Over a three-year period (2018–2020), 11 patients with ESRD underwent successful kidney transplantation under the guidance of the TMG. The expert team also instructed the local team on the implementation of plasma exchange therapy for highly sensitized patients, particularly those exhibiting DSAs and elevated levels of PRA. In this period 2 candidates who were DSA positive underwent plasma exchanges using fresh frozen plasma and rituximab infusion.
In 2020, the local surgical team independently performed their first KT procedure, marking a significant milestone. As of July 2024, a cumulative total of 40 kidney transplantation procedures was conducted, with the local team performing 29 of these procedures without assistance. Most of the candidates on whom the local team performed KT were low risk.
The current focus of the transplant program is on living-related KT, which primarily involves genetically related donors and spouses with matching blood groups. Furthermore, 2 DSA-positive candidates were successfully transplanted after 2 or 3 sessions of plasma exchange (for class I/II or combined class I/II DSAs, respectively) using fresh frozen plasma and a two doses of 200 mg rituximab infusion. The decision to proceed with transplantation of sensitized candidates with consultation with our mentors from Japan. Always we sought expert onion from them for complex and challenging cases in order to optimize management strategies and determine the most appropriate course of action.
Consequently, these advancements have significantly enhanced the diagnostic capabilities of BMH and leveraged its existing infrastructure to support complex surgical and medical interventions. The hospital now has modern operating theatres equipped for both kidney transplantation and open-heart surgery. Its ICUs are proficient in managing critical and life-threatening conditions.
Advanced imaging technologies, including pre-existing 3 Tesla MRI and a 256-slice CT scan, are now integral for the comprehensive evaluation and diagnosis of kidney transplant candidates and associated medical conditions. The hospital laboratory has undergone significant upgrades, incorporating high-technology equipment capable of performing a comprehensive suite of essential tests for KT. These methods include clinical chemistry, serology, microbiology, virology, and therapeutic drug monitoring assays. The pharmacy department ensures a consistent supply of all necessary medications, including immunosuppressive drugs and essential consumables, which are currently sourced internationally.
Our current KT program involves a multidisciplinary team. Implantation of the kidney, which includes vascular anastomosis, is performed by a surgical team consisting of four general surgeons and two vascular surgeons. Open donor nephrectomy, ureteric anastomosis, and stent insertion and removal are conducted by a team of six urologists involved in the program. Other team members in the program includes two nephrologists, one anesthesiologist, four operating theatre nurses, one pharmacist, and two laboratory technologists, each contributing their specialized expertise to the overall process.
Methodology
This retrospective cohort study included 37 patients who underwent kidney transplantation between 2018 and 2024. The transplantation protocol was adapted from Shonan Kamakura General Hospital, Japan, and included induction therapy with basiliximab and intravenous methylprednisolone, followed by maintenance immunosuppression with mycophenolate mofetil or mycophenolic acid, tacrolimus, and oral prednisolone. Sensitized patients, defined by the presence of DSAs and high PRA levels, received rituximab and plasma exchange as part of a desensitization protocol.
A standardized English-language data tool was used to obtain information from the electronic medical records, transplant registries, and paper charts. The collected information included sociodemographic characteristics, donor‒recipient relationships, immunosuppressive regimens, and laboratory results collected at or beyond one-year post transplantation. The primary outcomes were patient survival, defined as the time from transplantation to death from any cause, and graft failure, defined as a return to maintenance hemodialysis or retransplantation.
Data were entered and analysed via SPSS version 27, and data consistency was verified before analysis. Analysis was performed via the same software; continuous variables are reported as medians with interquartile ranges, whereas categorical variables are presented as frequencies and percentages. K‒M survival curve analysis was performed to estimate patient survival at 1, 3, and 5 years post transplant.
Results
Biographical information of transplant recipients
A total of 37 post KT recipients who underwent transplantation between March 2018 and March 2024 were included in the analysis. The median age of the recipients was 50 years (IQR: 39–56). The majority were male (70%), and 81% of the recipients were aged 35 years and above. Most kidney donors (84%) were blood-related to the recipients, whereas 16% were unrelated, primarily spouses. Hypertension (43.2%) and diabetes mellitus (32.5%) were the leading causes of chronic kidney disease (CKD). Over one post-transplant median serum creatinine level was 112 µmol/L (IQR: 93.83–146.62), and the median tacrolimus level was 5.37 ng/mL (IQR: 4.14–6.55). Additional biochemical parameters are summarized in Table 1.
Table 1.
Biographical information of transplant recipients (N = 37)
| Variable | n (%) or Median (IQR) |
|---|---|
| Age Median (IQR) | 50 (IQR: 39–56) |
| Gender | |
| Male | 26 (70%) |
| Donor’s Relationship | |
| Blood related | 31(84%) |
| Causes of CKD | |
| Hypertension | 16 (43.2%) |
| Diabetes | 12(32.5%) |
| Other | 9(24.3%) |
| Post kidney transplant recipient biochemical factors (over one year) | |
| Creatinine (µmol/L) | 112 (IQR: 93.83–146.62) |
| Urea (mmol/L) | 5.45 (IQR: 4.15–7.8) |
| DSA HLA Class 1 | |
| Positive | 3 (8.11) |
| DSA HLA Class 2 | |
| Positive | 1 (2.70) |
| DSA HLA Class 1 and 2 | |
| Yes | 35 (94.60) |
| Tacrolimus (ng/mL) | 5.37 (IQR: 4.14–6.55) |
| Hemoglobin (g/dL) | 13.8 (IQR: 12.8–15.1) |
| White blood cells (×10⁹/L) | 5.77 (IQR: 4.46–7.09) |
| Cholesterol (mmol/L) | 5.06 (IQR: 3.81–5.88) |
| Sodium (mmol/L) | 141 (IQR: 138.1–145) |
| Potassium (mmol/L) | 4.64 (IQR: 3.9–5.04) |
Survival rate
Overall patient survival rate
The median follow-up time for post KT recipients was 3 years, the Kaplan‒Meier survival curve (Fig. 2) shows that the cumulative survival probability remained high in the first 2 years of the observation period, with a decline occurring in the 3rdnd post transplantation. The patient survival rates at 1, 3, and 5 years were 97%, 81%, and 81%, respectively as shown in Fig. 2. The overall estimated mortality rate was 37.3 (95%CI: 14.0–99.4) per 1000 person per years, indicating favourable long-term outcomes for kidney transplant recipients in this low-resource setting.
Fig. 2.
Overall patient survival rate of KT recipients
Graff survival rate
The graft survival rates at 1, 3, and 5 years were 94%, 90%, and 90%, respectively as shown in Fig. 3.
Fig. 3.
Graff survival rate
Challenges for sustainable kidney transplant program
Kidney transplantations were performed by general surgeons, vascular surgeons and urologists. Open donor nephrectomies were conducted by urologists, as shown in Fig. 4 There were 2 general pathologists without a specialty of Nephropathology.
Fig. 4.
Showing the distribution of founding KT human resource team
Induction and maintenance were sourced entirely from outside the country. Histocompatibility tests (HLA, CDC, DSA and PRA) were outsourced to lancet laboratories or metropolises. In the period of 6 years, 103 ESRD patients were evaluated for KT, 11% were ready but did not have kidney donors. 30% of individuals have self-funded KT procedures. The majority (90%) of transplant recipients received their maintenance immunosuppressive drugs through the National Health Insurance Fund (NHIF) (Table 2).
Table 2.
Challenges of the kidney transplant program
| Variable | Frequency (percent) |
|---|---|
| Availability of immunosuppressive drugs | |
| Induction immunosuppressive drugs | 100% |
| Maintenance immunosuppressive drugs | 100% |
| Supply chain of immunosuppressive | |
| Sourced from outside the country | 100% |
|
Histocompatibility tests HLA, CDC, DSA and PRA Outsourced to other laboratory Donor availability for 103 recipients |
100% |
| Recipients with donors who met criteria | 55(53%) |
| Recipients with unfit donors | 37(36%) |
| Recipients with no donors | 11(11%) |
| Sponsorship of kidney transplant procedure | |
| Employer | 14(38% |
| Self | 11(30%) |
| Government | 12 (32%) |
| Sponsorship of maintenance immunosuppressive drugs | |
| National Health insurance fund | 33(90%) |
| Self | 2(5%) |
| Employer | 2(5%) |
Discussion
Successfulness of the kidney transplant program
Since 2018, our hospital has been providing live-related KT services. In the six years of the program, 40 patients with ESRD had undergone transplantation as of July 2024.
This study revealed good graft and patient survival rates at 1, 3, and 5 years after kidney transplantation. The graft survival rates at 1, 3, and 5 years were 94%, 90%, and 90%, respectively and the patient survival rates at 1, 3, and 5 years were 97%, 81%, and 81%, respectively. The findings of this study were similar to those of a meta-analysis of children after KT, which also revealed grafts and patient survival rates at 1 year, 3 years, 5 years, 7 years and 10 years after transplantation [17]. Similarly, several other studies in both higher- and lower-income countries reported good graft and patient survival rates at 1-, 3-, 5- and 10-year follow-ups [12, 14, 18–24].
Factors that might have contributed to good outcomes included good pre transplant evaluations and post-transplant care. Extensive recipients and donor assessments of the risks of rejection and infections, including viral infection, and proper selection of recipients who are not older than 60 years, where there are fewer complications, such as atherosclerosis and cardiovascular complications, are needed [25]. Moreover, recipients were given the recommended protocol for immunosuppression, which consisted of the induction of immunosuppressive drugs such as basiliximab or rituximab combined with plasma exchange for recipients with positive DSAs and high PRA and maintenance immunosuppressive drugs such as tacrolimus, mycophenolate mofetil or mycophenolic acid and steroids, as recommended by the KDIGO guidelines for KT [26, 27]. The opportunistic infections were prevented by administering the prophylactic fungicide nystatin oral suspension for fungal infection, valganciclovir and isoniazid, as recommended by the KDIGO guidelines for KT [2].
Challenges of kidney transplant programs
Notwithstanding the favorable outcomes and the continuous operation of the KT program for more than six years within our setting, certain challenges necessitate further attention to ensure smooth delivery of KT services. These include unreliable and unsustainable supplies of immunosuppressive medications and essential consumables, as domestic production of these materials is entirely absent. Furthermore, important histocompatibility tests, such as HLA typing, CDC cross matching, DSA detection, and PRA assessment, are exclusively outsourced. Currently, the samples of these tests are sent to either Lancet Laboratories (South Africa-based) or Metropolis (India-based) through their Tanzanian branches for analysis in their respective countries. Relying on this outsourcing method leads to long turnaround times, hindering the prompt execution of tests critical for urgent patient care.
Another challenge was the shortage of suitable kidney donors. Over the six-year program period, 103 patients ESRD were evaluated for Kidney KT. Notably, nearly half (47%) did not proceed with transplantation due to donor-related issues: 11% lacked potential donors entirely, and 36% presented donors who were medically unfit. Despite large family sizes in Tanzania, low kidney donation rates may be linked to insufficient knowledge, misinformation, negative perceptions, a significant family history of diabetes (potentially affecting donor eligibility), and rejection in kidney donation due to familial conflicts.
A shortage of skilled personnel remains a significant challenge, particularly given that kidney transplantation is a relatively new service in many developing countries with few training institutions in Africa offering comprehensive KT programs. While our Hospital is committed to the continuous capacity development of the KT team within our KT program, the key obstacles are financial constraints and the limited availability of training institutions for our experts to gain essential hands-on experience. Nevertheless, our established relationship with TMG continues to provide valuable advice and mentorship, which is vital for ensuring the program’s sustainability.
Additionally, KT services are expensive, making them unaffordable for most people. Currently, KT procedures are sponsored by the government, self-funded, and a few private insurance companies. The NHIF, a government-owned insurance company, covers only immunosuppressive drugs and post kidney transplant care.
Other studies in African countries, including those from MNHs, reported similar challenges, such as an unreliable supply of kidney transplant materials, a shortage of kidney donors and limited funds for KT services [10, 11, 13]. Wide socioeconomic disparities, high risk of infection posttransplant due to the infectious disease burden, insecure access to and monitoring of immunosuppression, and a lack of legislation on organ donation and brain death in many countries are other challenges that hinder the establishment of KT in many African countries [10].
Suitability and future plan
To sustain the kidney transplant program, TMG from Japan has agreed to support the construction of a kidney disease and transplant centre at BMH. This centre is expected to serve as a hub for KT and training, representing a joint project between BMH and UDOM.
In this joint project, BMH will run KT services, and UDOM will provide training programs such as fellowships in KT and a master’s degree in renal services for pathologists, immunologists, nurses, and laboratory scientists.
Furthermore, the upcoming implementation of insurance coverage for all citizens of Tanzania is a significant solution for enhancing KT services. The hospital is also exploring other funding opportunities, such as establishing a foundation to collect donations for individuals in need.
Conclusion
BMH has a successful sustained KT program by a local team after training and mentorship from Japanese experts. The outcomes of transplant recipients at 1, 3 and 5 years were good and comparable to those in developed countries. The hospital has demonstrated unique experience in establishing and sustaining KT services in the past 6 years, indicating that low-income countries can establish KT programs.
Limitations
These findings cannot be generalized because it was an observational study, and the sample size was small. The time to observe long-term outcomes related to transplant complications was only 6 years because the program has been in place for 6 years since it started. Moreover, there was generally poor knowledge and awareness among individuals regarding kidney donation and transplantation, which may have influenced their willingness to donate or seek transplantation and affected the accuracy of some responses. Additionally, the high financial cost of KT poses a significant barrier for many patients, potentially limiting access to the procedure and follow-up care. Last, consistent follow-up of transplant recipients was challenging, as many patients came from various regions across the country, making it difficult to ensure regular post-transplant monitoring and data collection.
Recommendations
On the basis of the findings of this study, we recommend conducting a follow-up study to assess the long-term outcomes of KT, including graft survival and patient quality of life. Additionally, our approach to KT has demonstrated promising outcomes in a low-resource setting. We therefore recommend that similar settings consider adopting and adapting our model to improve access to and the success of KT programs.
Acknowledgements
Sincere appreciation goes to the board of trustees, the executive director, the management of BMH, the Vice Chancellor and the management of the UDOM and the chairperson of the TMG and the management for their directives in the establishment of kidney transplantation services, instructions and permission to conduct this study. We are grateful to all the transplant surgeons, Nephrologists, Anesthesiologists, Pharmacists, Nurses and all the other staff of BMH and from the UDOM for their valuable contributions to establishing KT services at BMH. Finally, we thank the unit of information and technology of BMH for providing the data.
Abbreviations
- BMH
Benjamin Mkapa Hospital
- CKD
Chronic Kidney Disease
- DSA
Donor Specific Antibody
- ESRD
End Stage Renal Disease
- KT
Kidney Transplant
- MOH
Ministry of Health\
- PRA
Panel Reactive Antibody
- UDOM
University of Dodoma
Author contributions
K.C.S. Conceptualized the designer of the study, collected data, wrote the report and prepared the manuscript of this study A.N.M. and A.B.C. participated in the study design. A.N.M. participated in critical review of the manuscript A.N.M., A.C, M.M., A.M., S.K., S.H, T.K., A.M., D.M, S.M, O.S., R.M., V.K., V.M., R.R., A.T, H.I., D.R., A.G., N.K., and C.B. involved in the establishment and sustainability of KT program at BMH and critical review of the manuscript. A.K., retrieved the data from the Hospital management information system.
Funding
No funding was obtained for this work.
Data availability
The datasets used and/or analysed during the current study are freely available from the corresponding author upon reasonable request via email: kessyshija@gmail.com.
Declarations
Ethical approval and consent to participation
The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The permission to review the patient data was approved by the Institutional Review Board (IRB) of BMH, Directorate of Training and Clinical Research. Permission to access and review patient data was granted by the IRB. Informed consent to participate was obtained from all individuals involved in the study, and confidentiality was maintained throughout the research process.
Consent for publication
Consent for publication was obtained from the Institutional Review Board (IRB) of Benjamin Mkapa Hospital (BMH) under the Directorate of Training and Clinical Research.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Citations
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Data Availability Statement
The datasets used and/or analysed during the current study are freely available from the corresponding author upon reasonable request via email: kessyshija@gmail.com.