2020: Special Issue on Kidney Transplantation  Supp 1

Background:  End-stage kidney disease is a growing and leading cause of morbidity and mortality worldwide, thus the need of renal replacement therapy (RRT), defined as dialysis or kidney transplantation, is expected to rise. In Africa, RRT was available as early as 1957, but initiation and maintenance of the service remains a major challenge for many parts of the continent.

Objectives: This study aimed to document the major historical milestones that were achieved to successfully establish renal replacement therapy in Ethiopia and the lesson learned from a historical point of view.

Method: This study utilized mixed method of quantitative and qualitative study. Data was collected from June 1, 2018 – July 30 2018. Data about the hemodialysis service in all parts of the country was collected by structured questionnaire, and a descriptive analysis was performed. The data about kidney transplant service was collected from the only transplant center in the country, St Paul’s Hospital Millennium Medical College (SPHMMC). 

Result:- The first dialysis service started in 1980 at Tikure Anbessa specialized hospital  but a maintenance  dialysis service started in 2001 at St Gabriel Hospital. The expansion of the service was restricted to Addis Ababa until recently, and majority of the dialysis service was provided by the private sector. The first successful human kidney transplant happened in September 2015 at SPHMMC.

Key words;- Renal Replacement therapy, Dialysis,  Kidney Transplant ,Ethiopia ,Historical milestone

Background – The Ethiopian kidney transplantation program was recently established. Except the transplant surgeon most professionals involved were new or has very little experience on kidney transplant.

Objectives – To evaluate if simulation with a porcine helped develop the ability of the new kidney transplant center for human living donor nephrectomy and recipient kidney transplantation.  

Methods and materials – A retrospective review of the reports of the transplant surgeon, nursing and anesthesia team and in-depth interviews of everyone involved in the swine simulation was performed. Additionally, a self administered questionnaire was used to collect data on individuals’ perception of the simulation                                                                        Conclusions; - The experience, the knowledge and skills gained from porcine living donor and recipient transplant simulations were significant that we recommend using such simulation to test a new service in a new center.  Simulation session need to be performed until the team is comfortable and all gaps are identified.

Key words – swine, simulation, surgical skill, test

Background

End stage renal disease (ESRD) is emerging as a major public health problem worldwide.  Kidney transplantation is the treatment of choice for patients with ESRD, but its attendant surgical complications pose significant concern to the outcome of kidney transplantation surgery. Objective:

To review surgical complications and outcomes of live donor kidney transplant recipients in our centre.

Methods

We retrospectively analyzed all surgical complications among kidney transplant recipients performed from September 2015 to August 2017.

Results:

  A total of 52 live related kidney transplant surgeries were performed during this period. The male to female ratio was 3.3:1. Patient age range from 16 to 60years with mean age of 34.5years (SD= 10.4). BMI of patients ranged from 15.3 to 30.6kg/m² with mean of 20.1(SD=3.5). The majority of patients received kidney from siblings 24(46.2%).

 The etiology of ESRD was unknown in 63.5% of cases, whereas chronic glomerulonephritis, diabetes mellitus and hypertension accounted for 13.5%, 7.7% and 3.8% respectively.

Post surgical complications occurred in 8patients (15.3%) and most complications were related to surgical wound (9.6%).There was one urologic complication (1.9%) due to ureteric kink. Lymphocele occurred in 1 patient (1.9%).

Conclusion:

With proper planning and support, kidney transplant surgery can be a safe treatment modality for patients with ESRD even in a resource limited facility. Our rates of surgical complications were within those reported by other series.

Key words: ESRD, Kidney transplantation, surgical complications

Background: Kidney transplant is the current modality of choice as a renal replacement therapy due to superior patient survival and quality of life than both peritoneal and hemodialysis. The service is limited outside ofdeveloped countries due to the requirement for structured organization, extended expertise, and qualified supportive laboratory, as well as extensive health system service support in general.

Objective: The aim of the study is to describe renal allograftrecipient outcomes during the first two years following establishment of the national kidney transplant center in AddisAbaba, Ethiopia.

Methods: A retrospective review of the case records of all recipients of renal allografts at Saint Paul’sHospital MillenniumMedical College between September 2015 and August 2017 wasdone.

Results:52 live donor kidney transplants were performedover two years.The cause of native kidney diseases was unknown in majority(32.6%),while chronic glomerulonephritis accounted for 30.8%. One fourth of recipients were transfused at least once before transplant. There was no biopsy proven rejection episode. There was one early graft loss from unknown cause. Atleast one organ system was affected with drug side effects in nearly in all(96%), leucopenia occurring in one fourth(22%) was very serious.Death censored graft survival at one year is 97.5% while mean GFR at one week, three month, six month and one year was 73.1, 93.6, 95.6, and96ml/min, respectively.After successful kidney transplant pre-transplant hypertension subsided in 46.5% of patients.

Conclusion: Graft survival and graft function at one year, were excellent, and comparable to excellent centers worldwide.

Key Words – Ethiopia, kidney, transplant, outcome

Introduction: Chronic kidney disease (CKD) is defined as the presence of one or more markers of kidney damage for greater than 3 months. If not treated, it leads to other complications and decreased quality of life. The global burden of CKD is increasing accompanied by increase in need of kidney transplantation increasing the number of living donors in parallel. Studies show that kidney donation has a medical risk to the donor showing difference based on varying demographics. In Ethiopia there is no previous study regarding donor’s risk of medical complication.

Objectives: To assess medical outcome of renal allograft donors at the national kidney transplant center- Saint Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.

Methods: A hospital based retrospective chart review study was conducted at SPHMMC among 43 kidney donors who were on follow up from September 2015 to August 2018. Data was collected using pretested data abstraction tool. Epi-Info version 7.2.1.0 was used for data entry and SPSS version 23.0 and STATA version 14.1 were used analysis.

Results: Median duration of follow up was 12 months. The incidence rate of CKD and hypertension among the donors during the three years observation period was on average 4.1 per 100 person years of observation and 8.2 per 100 person years of observation respectively.

Key words: Renal allograft donor, medical outcome, retrospective chart review, survival analysis, Ethiopia

Introduction: Metabolic syndrome (MS) is a cluster of risk factors for cardiovascular diseases (CVD). It is also common in renal transplant recipients and is associated with increased risk of graft dysfunction and cardiovascular mortality. Its magnitude is not known in our Ethiopian patients.

Objective: To determine the magnitude of metabolic syndrome and associated factors.

Methods: Analytical cross-sectional design was used. Eighty-seven Ethiopian renal transplant recipients having follow-up at St. Paul Hospital’s National Kidney Transplant Centre were studied from May to July, 2018. A structured data collection format was used to collect data. Contextualized “WHO STEPS Instrument for Non-communicable Diseases Risk Factor Surveillance” was utilized for collecting data on behavioral risk factors, biophysical measurements and laboratory tests. 

 Results: Majority of the patients were males, 64 (73.6%). Most of them were young with mean age of 35.8 (+11.9) years. Hypertension (HPN) was the commonest component of MS accounting for 49 (56.3%) of cases. The magnitude of metabolic syndrome was 34.5%. Only central obesity (P. value = 0.046; AOR 39.1 (1.1, 141) and hyperglycemia (P=0.031; AOR 25.1(1.3, 467.8) were significantly associated with metabolic syndrome.

Conclusion and Recommendations: The magnitude of MS was high in our transplant recipients. However, only waist circumference and hyperglycemia were found to have significant association with MS. Comprehensive preventive strategies should be implemented for management of MS to minimize its impact.

Key Words: Metabolic syndrome, renal transplant, DM, HPN, Dyslipidemia, Central Obesity, Ethiopia.

 Background:-Organ transplantation is the most effective and desirable method of treatment for patients suffering from end stage organ failure secondary to any cause. This scientific method grants a second lease of life for many in need. Since the first successful transplants were made in the 1950s this area of medicine has shown tremendous advancements. In fact, the main problem currently facing transplant medicine lies in the discrepancy between global need for donor organs and the demand, which by many is believed to be because of lack of adequate Knowledge and poor attitude towards organ donation among the public. Since medical students are the future physicians it is very important to assess their level of understanding and improve their knowledge and attitude towards organ donation accordingly so they can in turn promote the public.

 Objective: -To assess the knowledge, attitude and associated factors about organ donation among medical students of SPHMMC.

Methodology: A descriptive cross-sectional study was conducted among medical students of SPHMMC, Addis Ababa, Ethiopia. from March 12, 2018 to May 07, 2018. The study was conducted on a sample size of 240 medical students. Data was collected through structured self-administered questionnaire consisting of 31 questions on knowledge and attitude towards organ donation.