Experience and challenges of care of post kidney transplant patients in a resource poor non-transplant center

Background: In recent times a number of privileged end stage kidney disease patients from the sub-Saharan African countries embark on offshore kidney transplant to other continents, mostly India. Non-transplant renal units in the region are increasingly faced with the long term care of such patients with inherent challenges. We present our experience and challenges of providing care for such patients at the University of Port Harcourt teaching hospital in Nigeria. Objective: To determine the outcomes and challenges of care of off-shore live-donor post-transplant patients in a non-transplant center. Methods: Retrospective analysis of the clinical data of all post- kidney transplant patients from 2000 to 2015 was done. Results: Twenty live-donor post-transplant patients with M/F ratio of 3:1 and a mean age of 42.6 ± 8.3 (26-57) years were studied. 95% had their kidney transplant in India. Mean pre-transplant e-GFR was 8.4 ± 2.4 mls/min/1.73 m2 while at point of entry, post-transplant was 72.6 ± 29 ml/min/1.73 m2 (p<0.001). The commonest complication was graft dysfunction in 9 (45%). Others were NODAT 2 (10%), Polycythaemia 2 (10%), Sepsis, lower gastrointestinal haemorrhage and tuberculosis 1 (5%) each, respectively. Overall mortality was 10 (50%). 1-year survival (100%), 3-year survival (45%), 5-year survival (15%) and 10-year survival (5%). The longest survivor (alive) is 15 years post- transplant. There was no significant survival difference between biologically related and non-related donors (p>0.5).