Inequitable paediatric kidney transplantation in resource-limited countries: expert recommendations for Nigeria – a scoping review

Abstract

Background In Nigeria and other resource-limited countries (RLCs), paediatric kidney transplantation (PKT) uptake remains low, causing preventable deaths from kidney failure. Objectives This study identifies challenges and solutions for inequitable kidney transplantation (KT) in RLCs through a scoping review. Based on an analysis of questionnaires administered to Nigerian paediatric nephrologists (NPNs), consensus recommendations for expanding PKT in Nigeria are derived. Eligibility criteria The Population-Intervention-Comparison-Outcome framework extracts data on the Population (challenges beleaguering adult KT or PKT in RLCs), Intervention (solutions offered for KT/PKT) and Comparison/Outcome (successes of solutions) of published articles. Sources of evidence Literature published in the English language from January 2003 to December 2023 was sourced from PubMed, Scopus and African Journals Online and references from relevant articles. Methods Two reviewers independently analysed the studies using Arksey and O’Malley’s framework and Preferred Reporting Items for Systematic Reviews extension - Scoping Review guidelines. Using the most common solutions proposed for expanding KT in RLCs in the reviewed articles, a questionnaire was drafted to gain consensus among NPNs on solutions most suitable for the Nigerian setting. The NPNs used performance indicators, including efficiency, equity, quality of care, effects on catastrophic health expenditure and sustainability. To reach consensus, a solution had to satisfy all performance indicators and achieve at least 75% agreement among NPNs. Results Of the 41 065 records identified, 39 articles were included for syntheses. Key barriers included inadequate financing and organ availability. The respondents comprised fourteen NPNs from 13 Nigerian clinical sites. Agreed solutions include the formation of a Nigeria Transplant Community to oversee PKT expansion, public KT centres (one per each of the six geopolitical zones), generic immunosuppressants and local dialysate production to cut costs. Conclusions This study outlines a scalable pathway for PKT in Nigeria using a methodology adaptable to other RLCs. It emphasises government-backed financing and policy frameworks.