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Published on: March 27, 2018
Pediatric kidney transplantation in the developing world: challenges and solutions
S A H Rizvi1, S Sultan, M N Zafar
1Department of Urology, Sindh Institute of Urology and Transplantation, Dewan Farooq Medical Complex, Karachi, Pakistan.
Summary
Pediatric kidney replacement therapy (RRT) and transplantation are scarce in developing nations. A free, integrated public sector program significantly improved access and outcomes for children with end-stage renal disease (ESRD).
Area of Science:
- Pediatric Nephrology
- Public Health Policy
- Transplantation Medicine
Background:
- Pediatric RRT and transplantation rates are critically low in developing countries due to economic constraints and limited facilities.
- High costs of dialysis and transplantation, coupled with geographical barriers, lead to significant treatment refusal among children with ESRD.
- A substantial majority (75-85%) of children with ESRD in these regions are denied access to life-saving RRT and transplantation.
Purpose of the Study:
- To evaluate the feasibility and impact of an integrated, publicly funded pediatric dialysis and transplantation program in a developing country.
- To assess the effectiveness of a 'free of cost' model in improving access to RRT and transplantation for children with ESRD.
- To demonstrate the societal acceptance and long-term graft survival rates achievable with accessible pediatric transplantation.
Main Methods:
- Implementation of an integrated dialysis and transplant program supported by a community-government partnership.
- Provision of RRT and transplantation services at no cost to patients, including lifelong follow-up and medication.
- Longitudinal tracking of patient outcomes, including graft survival rates post-transplantation.
Main Results:
- Successfully performed 475 pediatric transplants over 25 years.
- Achieved high graft survival rates: 96% at 1 year and 81% at 5 years.
- Observed increased societal acceptance of transplantation as the preferred therapy for pediatric ESRD due to improved access.
Conclusions:
- Pediatric transplantation is achievable and highly successful in developing countries when made freely accessible through public sector initiatives.
- Integrated, publicly funded programs can overcome economic and logistical barriers, dramatically increasing access to RRT and transplantation.
- This model demonstrates a sustainable pathway to providing essential renal replacement therapies for children with ESRD in resource-limited settings.
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