The Transplant Gap: A Single-center 8-year Review of Referral Patterns and Factors Limiting Kidney Transplantation in...

Kidney transplantation services in Southeast Nigeria commenced in December 2017. This study evaluated referral patterns, transplant conversion rates, and barriers to kidney transplantation at a tertiary center.

This was a retrospective review of the kidney transplant registry at the Federal Medical Centre, Umuahia, Southeast Nigeria, from July 2017 to June 2025. Data extracted included referral sources, dialysis exposure (frequency and duration), kidney function at presentation, vascular access type, blood pressure, hemoglobin levels, transfusion history, etiology of kidney disease, transplant waiting list status, and transplantation outcomes. Reasons for failure to proceed to transplantation were also analyzed. Data analysis was performed using SPSS version 23 (IBM Corp., Armonk, NY, USA).

A total of 93 patients were evaluated. Of these, 47 (50.5%) were referred from dialysis centers within the host state, 27 (29.0%) from other centers in Southeast Nigeria, 14 (15.1%) from other parts of the country, and 5 (5.4%) from outside Nigeria. Most patients (88; 94.6%) were on dialysis at presentation, with a duration ranging from 1 to 28 months, whereas 5 (5.4%) presented for preemptive transplantation. Referrals were predominantly made by nephrologists (53; 56.9%), followed by other physicians (14; 15.1%), surgeons (11; 11.8%), and private practitioners (9; 9.7%). The mean estimated glomerular filtration rate at presentation was 13 ± 4.8 mL/min/1.73 m2, and the mean hemoglobin level was 9.5 ± 4.5 g/dL. Anemia was present in 91% of patients, with 57 (61.3%) having a prior history of blood transfusion. Only 13 patients (14.0%) underwent kidney transplantation, while 80 (86.0%) did not proceed to transplant. The major barriers included financial constraints (40%), donor incompatibility (20%), frailty (14%), advanced age >70 years (8%), human immunodeficiency virus infection (5%), hepatitis B or C infection (5%), and donor withdrawal (5%).

Most patients presented late with advanced kidney disease, significant anemia, and suboptimal dialysis preparation. The transplant conversion rate was low, largely due to financial barriers and donor-recipient incompatibility. Addressing these challenges is critical to improving access to kidney transplantation in resource-limited settings.