Living Kidney Donor Transplantation in a Resource-limited Country: The Ivory Coast Experience

Abstract

Renal transplantation that offers a good quality of life still is not performed by the majority of countries of black Africa. We started a pilot project of renal transplantation in Ivory Coast 2 years ago. The present paper reports the preliminary results, difficulties related to the program, and perspectives regarding its expansion. Ten living related kidney transplantations have been performed over a 2-year period. Recipients and their respective donors were male. The mean age of the recipients was 42.8 years (22–57), and the mean age of the donors was 29.4 years (22–43). The mean number of mismatches was 3.2 (0–6). None was immunized. Recipients and donors were all EBV IgG positive and CMV IgG positive. All but 1 case were induced with basiliximab. The mean graft and patient survival time was 16.6 months (6–26). The mean cold ischemic time was 2.27 hours (1–3.32). The mean serum creatinine at discharge was 241.87 μmol/L (115.18–1063.2), at 6 months was 117.20 μmol/l (95.6–139.9), at 12 months was 104.55 μmol/L (62.02–132.9), and at 24 months was 104.55 μmol/L (62.02–132.9). The mean cyclosporine through level (C0) at 6 months was 137.57 ng/mL (70–366), at 12 months was 117.33 ng/mL (62–197), and at 24 months was 78 ng/mL. The mean cyclosporine 2-hour post-administration concentration levels (C2) at 6 months was 764.9 ng/mL (430–1421), at 12 months was 937.17 ng/mL (483–1292), and at 24 months was 690.66 ng/mL (488–853). Main complications were sepsis, adenovirus hemorrhagic cystitis, new-onset diabetes after transplantation, delayed graft function, polycythemia, and cytomegalovirus infection. No clinical rejection was diagnosed over the 2-year period. Patient and graft survival was 100% at a mean post-transplantation time of approximately 16.6 months.