Implementation of a pediatric kidney transplantation program in Uzbekistan: Feasibility and early outcomes

Abstract

BACKGROUND Pediatric kidney transplantation is the treatment of choice for children with end-stage renal disease; however, access to transplantation remains limited in low- and middle-income countries. Uzbekistan had no prior institutional experience in performing pediatric living donor kidney transplantation (LDKT). AIM To report the implementation, surgical protocols, and clinical outcomes of the first pediatric LDKT program in Uzbekistan. METHODS This retrospective single-center study analyzed the first 20 pediatric LDKTs performed between April 2023 and February 2025. All donors were related family members who underwent either open or laparoscopic hand-assisted nephrectomy. Pre-transplant immunologic workup included HLA typing and anti-HLA antibody screening using solid-phase assays. Perioperative management was guided by Enhanced Recovery After Surgery Society principles. Primary outcomes included operative metrics, perioperative complications, graft function, biopsy-proven rejection, and patient/graft survival. Statistical analysis utilized descriptive statistics, Kaplan–Meier survival estimates, and Fisher’s exact test where applicable. RESULTS Donors included 13 women and 7 men (median age: 38 years; range: 31–50). Median operative times were 182.5 minutes for open nephrectomy and 198.5 minutes for laparoscopic nephrectomy. No major intraoperative complications occurred; one donor developed a postoperative wound seroma. All recipients (aged 87–207 months) exhibited immediate graft function, with no delayed graft function observed. Median cold and warm ischemia times were 15 minutes (range: 10–138) and 35 minutes (range: 18–40), respectively. Median serum creatinine decreased from 198 μmol/L on postoperative day 1 to 54 μmol/L by day 7. Three rejection episodes were reported, two of which occurred in sensitized recipients. Two graft losses were attributed to late rejection. One patient died from hemorrhagic stroke six months post-transplant. At 24 months, patient and graft survival rates were 95% and 90%, respectively. CONCLUSION The successful implementation of a pediatric living donor kidney transplantation program in Uzbekistan yielded favorable short- and intermediate-term outcomes, with high graft survival and low complication rates. This experience may provide a practical framework for initiating similar programs in other resource-constrained healthcare settings.