Felicia U Eke1, Taiwo A Ladapo2, Augustina N Okpere3, Olalekan Olatise4, Ifeoma Anochie3, Tochi Uchenwa3, Henrietta Okafor5, Paul Ibitoye6, Uchenna Ononiwu7, Ademola Adebowale8, Rosamund Akuse9, Seyi Oniyangi7. 1. University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. fellyeke@yahoo.com. 2. Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria. 3. University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. 4. Zenith Medical Centre, Abuja, Federal Capital Territory, Nigeria. 5. University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria. 6. Usman Da Fodio University Teaching Hospital, Sokoto, Sokoto State, Nigeria. 7. National Hospital, Abuja, Federal Capital Territory, Nigeria. 8. University College Hospital, Ibadan, Oyo State, Nigeria. 9. Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Abstract
BACKGROUND: Kidney transplantation (KT) is the gold standard treatment for children with chronic kidney disease stage 5 (CKD5). It is easily accessible in well-resourced countries, but not in low/middle-income countries (LMICs). We present, a multicentre experience of paediatric KT of children domiciled in Nigeria. We aim to highlight the challenges and ethical dilemmas that children, their parents or guardians and health care staff face on a daily basis. METHODS: A multicentre survey of Nigerian children who received KTs within or outside Nigeria from 1986 to 2019 was undertaken using a questionnaire emailed to all paediatric and adult consultants who are responsible for the care of children with kidney diseases in Nigeria. Demographic data, causes of CKD5, sources of funding, donor organs and graft and patient outcome were analysed. Using Kaplan-Meier survival analysis, we compared graft and patient survival. RESULTS: Twenty-two children, aged 4-18 years, received 23 KTs, of which 12 were performed in Nigeria. The male-to-female ratio was 3.4:1. Duration of pre-transplant haemodialysis was 4-48 months (median 7 months). Sixteen KTs were self-funded. State governments funded 3 philanthropists 4 KTs. Overall differences in graft and patient survival between the two groups, log rank test P = 0.68 and 0.40, respectively were not statistically significant. CONCLUSIONS: The transplant access rate for Nigerian children is dismal at < 0.2%. Poor funding is a major challenge. There is an urgent need for the federal government to fund health care and particularly KTs. Graphical Abstract.
BACKGROUND: Kidney transplantation (KT) is the gold standard treatment for children with chronic kidney disease stage 5 (CKD5). It is easily accessible in well-resourced countries, but not in low/middle-income countries (LMICs). We present, a multicentre experience of paediatric KT of children domiciled in Nigeria. We aim to highlight the challenges and ethical dilemmas that children, their parents or guardians and health care staff face on a daily basis. METHODS: A multicentre survey of Nigerian children who received KTs within or outside Nigeria from 1986 to 2019 was undertaken using a questionnaire emailed to all paediatric and adult consultants who are responsible for the care of children with kidney diseases in Nigeria. Demographic data, causes of CKD5, sources of funding, donor organs and graft and patient outcome were analysed. Using Kaplan-Meier survival analysis, we compared graft and patient survival. RESULTS: Twenty-two children, aged 4-18 years, received 23 KTs, of which 12 were performed in Nigeria. The male-to-female ratio was 3.4:1. Duration of pre-transplant haemodialysis was 4-48 months (median 7 months). Sixteen KTs were self-funded. State governments funded 3 philanthropists 4 KTs. Overall differences in graft and patient survival between the two groups, log rank test P = 0.68 and 0.40, respectively were not statistically significant. CONCLUSIONS: The transplant access rate for Nigerian children is dismal at < 0.2%. Poor funding is a major challenge. There is an urgent need for the federal government to fund health care and particularly KTs. Graphical Abstract.
Authors: Christopher I Esezobor; Adebimpe E Alakaloko; Bashir Admani; Rashid Ellidir; Peter Nourse; Mignon I McCulloch Journal: Curr Pediatr Rep Date: 2021-10-25