#3618 Three years of kidney transplantation in the Yaounde General Hospital, Cameroon

Abstract Background and Aims Hemodialysis has long been the unique long-term kidney replacement therapy available in Cameroon. Only few financially viable patients could benefit from kidney transplantation abroad. In 2021 Yaounde General Hospital began a living related donor kidney transplantation program in collaboration with the Hopitaux Universitaire de Genève. We hereby present, the strengths and weaknesses of the program. Method This is an observational cross sectional study of kidney transplantations done in the Yaounde General Hospital from 2021 to 2024. At the beginning of the program compatibility tests were done at the Geneva University Hospitals and a transplant surgeon from the same hospital performed the transplantation with a local surgical team of vascular surgeons and urologists. Selection of donors and recipient, their evaluation prior to transplantation and their follow-up was done by the local team and the Geneva team by videoconference. Most of the tests were done in the hospital and few viral serology tests were done abroad. Renal pathology was not available. The whole process was free of charge for the patient. In the last year, the hospital owns a Luminex and therefore performs compatibility tests locally and in the same last year, the local surgical team solely performs the whole transplantation procedure. Results A total of fourteen patients have been transplanted (1st year: 04, 2nd year: 03, and 3rd year: 07), with 07 (50%) recipients and 09 (64.3%) donors being males. It was the first transplant for all recipients. The mean age of recipients was 30.57 ± 6.06 years and mean age of donors was 34.85 ± 9.77 years. Dialysis vintage ranged from 3 months to 14 years with a median of 7 [3–11] years. Concerning the relationship between donors and recipients, we had 7 brothers, 3 sisters, 1 cousin, 1 mother, 1 uncle and 1 aunt. In all, 5 pairs were HLA identical (one homozygous twins), 6 pairs HLA semi-identical and 3 HLA different. There was no donor specific antibody. The homozygous twin received no immunosuppressive therapy. Twelve recipients received basiliximab and one thymoglobulin as induction. In addition to mycophenolic acid, eleven received cyclosporine, and two received tacrolimus as maintenance therapy. Corticosteroids were stopped at 6 months for all the recipients. No cases of acute rejection were recorded. All but one patient recovered normal kidney function after 2 weeks of transplantation. Two immediate complications were observed and successfully corrected. Two early complications occurred in two patients (one lymphocele with ureteral compression treated by laparoscopy and one delayed wound healing). Three female recipients experienced a single episode of urinary tract infection while two had recurrent urinary tract infection. The kidney function of all the recipients has been stable since their surgery. One of the female recipients (homozygote twin) gave birth to a healthy baby after 17 months of the transplant. Conclusion Three years after the beginning of the first transplantation program in Cameroon, the outcome of patients is satisfactory. Local expertise has grown with total independence. However, the absence of renal pathology remains the main issue.