Managing Immunological High Risk Kidney Transplant Patients In Nigeria, A Microcosm Of Resource-Constrained Setting; Evidence And Practice.

: Black patients awaiting transplantation are more likely to be immunologically sensitized than White, Hispanic, or Asian patients. In Nigeria, the situation is compounded by multiple blood transfusions before and during dialysis, including patients on the waiting list for kidney transplantation. Tailored immunosuppressive regimens and allocation policies are being explored to address the unique genetic and immunological profiles of Black patients and improve outcomes. Comparing practice in the selected Nigerian center with international and local guidelines on induction immunosuppression is the main crux of this review. This review focused on current practices in induction regimen for kidney transplantation in immunologically high-risk patients in a Nigerian transplant setting, explores its outcome and compares this practice and its outcome with practice in other centers and international kidney transplant guidelines. Keyword searches of academic databases - PUBMED, SCOPUS, AJOL, Cochrane, ISI, Google scholar and IBSS databases were conducted. Manual searches of other relevant journals and reference lists of primary articles. Anti-thymocyte globulin remains the choice of induction agent, with the same dose used for both non sensitized and highly sensitized patients. Induction regimen used in the index center was given for a shorter duration of 3-5 days when compared to standard guideline recommendations of 21 doses over 28 days. However, the 3-month and 12-month graft outcome obtained was 90% and 90%, respectively, in the index center; and this was comparable to the outcome in centers where the standard protocol was employed. There is no change in the choice of immunosuppressive agent for kidney transplant in Nigeria and other centers and guidelines reviewed. With ongoing efforts to reduce the widening gap in transplant care by having an individualized approach to care, this narrative explores current practices in a resource-constrained setting as compared to guideline recommendations and provides a basis for future studies.