Escalating Costs and Declining Access: Kidney Transplantation in a Resource-Constrained Nigerian Healthcare System – Chasing a Moving Target

BACKGROUND: Kidney transplantation offers the best quality of life and long-term survival for patients with end-stage renal disease. However, its high cost in Nigeria, largely borne out-of-pocket by patients, renders it largely unaffordable for the average citizen. OBJECTIVES: The objectives of this study were to document changes in the cost of kidney transplantation over time and assess the main determinants of such changes and any effect on patient access to kidney transplantation (uptake of the surgery). MATERIALS AND METHODS: This was a retrospective study of transplant register and direct cost implications of medications and services for kidney transplantation at the Federal Medical Centre, Umuahia, Southeast Nigeria, from June 2017 to May 2025. RESULTS: There was a significant escalation in the total cost of kidney transplantation from N0 in 2017 (full subsidy by the hospital) to N22 million ($12,580 USD) in 2025 (no subsidy), which comprises a progressive increase in cost of laboratory investigations, medications/surgery, and admission from N0 in 2017 to N7.5 million ($4285 USD), N10.5 million ($6000 USD), and N4 million ($2285 USD), respectively, in 2025. There was a corresponding reduction in the number of transplants per year from a maximum of 3 in 2020 to 1 in 2025. The induction immunosuppression medication and human leukocyte antigen (HLA)-tissue typing were the service items with the highest cost than others. CONCLUSION: There was a progressive increase in the patient-borne cost associated with kidney transplantation, with a reduction in transplant volumes per year. Cost of medications (especially induction regimen) and HLA-tissue typing appear to weigh more on the total cost than other items.