Patient and Graft Survival Rates at 5 Years following Kidney Transplant at the National Transplantation Center in Ethiopia

Background: In Ethiopia living donor kidney transplantation was started in September 2015 at the National Transplantation Center. The center was established in Saint Paul Hospital Millennium Medical College (SPHMMC) in collaboration with the Ethiopian Federal Ministry of Health and Michigan University. One year death censored graft survival rate was 98.5%. This study was conducted to determine five-year patient and graft survival among the cohort of recipients operated from September1 2015 to November 15 2018. Methods: A retrospective study of the cohort was conducted. Recipient and donor data were collected from the medical records using a structured printed tool. The collected data were entered and analyzed using IBM SPSS statistics version 29.0.2.0. Five-year graft and patient survival rates were determined. Predictors of five year patient and graft survival were identified using logistic regression. Ethical clearance was obtained from the institutional review board of SPHMMC. Data collection took place from November 15 to December 12 2023. Results: Ninety two recipients were included. Mean + SD age was 34.07 + 11.26 years. Sixty-four (68.8%) were male. Mean + SD age of donors was 34.9 + 11.9 years. All except 9 (9.8%) were related to the recipient. Basiliximab was the induction regimen for 93.5%. Tacrolimus, MMF and prednisolone were maintenance immunosuppressive for 95% of recipients. Five year patient survival was 83.7%. Age > 40 years, longer duration of post-op admission, serious infection during follow-up, graft rejection and graft biopsy predicted significantly reduced five year patient survival. OR (95% CI) were 0.19 (0.05-0.77), 0.92 (0.86 - 0.99), 0.06 (0.01 - 0.47), 0.14(0.03-0.64) and 0.21(0.06 - 0.74) respectively. Tertiary education predicted better five year patient survival OR (95% CI) 6.73(1.16-39.09). Five year death censored graft survival was 90%. Donor 24 hour urinary protein level, record of graft rejection and number of hospital admissions predicted reduced five-year death censored graft survival with OR (95% CI) of 0.98 (0.96 – 0.99), 0.01(0.001-0.1) and 0.39 (0.22 – 0.71) respectively. Conclusion: Five year survival rate of recipients at the National Transplantation Center of Ethiopia is acceptable. The death censored graft survival rate at five years is comparable to those in developed regions. Funding: Government Support – Non-U.S.