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Review
. 2022 Apr;37(4):745-755.
doi: 10.1007/s00467-021-05070-3. Epub 2021 Apr 10.

Paediatric kidney transplantation in under-resourced regions-a panoramic view

Arpana Iyengar  1 , M I McCulloch  2
Affiliations
Review

Paediatric kidney transplantation in under-resourced regions-a panoramic view

Arpana Iyengar et al. Pediatr Nephrol. 2022 Apr.

Abstract

Kidney transplantation is the ideal choice of kidney replacement therapy in children as it offers a low risk of mortality and a better quality of life. A wide variance in the access to kidney replacement therapies exists across the world with only 21% of low- and low-middle income countries (LLMIC) undertaking kidney transplantation. Pediatric kidney transplantation rates in these under-resourced regions are reported to be as low as < 4 pmcp [per million child population]. A robust kidney failure care program forms the cornerstone of a transplant program. Even the smallest transplant program entails a multidisciplinary workforce and expertise besides ensuring family commitment towards long-term care and economic burden. In general, the short-term graft survival rates from under-resourced regions are comparable to most high-income countries (HIC) and the challenge lies in the long-term outcomes. This review focuses on specific issues relevant to kidney transplants in children in under-resourced regions by highlighting limitations in the capacity and health workforce, regulatory norms, medical issues, economic burden, factors beyond financial hardship and ethical considerations relevant to these regions. Finally, the perspective of strengthening transplant programs in these regions should factor in the bigger challenges that exist in achieving the health-related sustainable development goals by 2030.

Keywords: Barriers; Challenges; Developing nations; Low middle-income countries; Outcomes; Paediatric kidney transplantation; Under-resourced regions.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Total rate (pmp) of kidney transplants undertaken across regions from the global database on donation and transplantation website
Fig. 2
Fig. 2
Essential components of a sustainable paediatric transplant program at various levels of health care relevant to LLMIC based on reference . *Universal health coverage
Fig. 3
Fig. 3
Components of health-related SDG that potentially impact paediatric transplantation in under-resourced regions [7, 87]
See this image and copyright information in PMC

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