The Current state of kidney transplantation in Kenya: challenges, opportunities, and future directions

Abstract

Kenya, a lower-middle-income country in East Africa, faces a rising burden of chronic kidney disease (CKD), with an estimated 12,500 individuals suffering from end-stage renal disease (ESRD). Renal transplantation—the preferred treatment option for ESRD, remains underutilized. Since the first transplant in 1978, seven centers have been established, with 829 transplants performed by 2022. Living-related renal transplants (LRRT) dominate, while deceased donor renal transplantation (DDRT) is yet to be implemented. Recent data show improved outcomes, with one-year graft survival rates up to 96%, but challenges such as acute rejection rates (32.8%) and limited donor outcome data persist. Barriers include high costs, limited insurance coverage, inade- quate laboratory infrastructure, and a transplant workforce shortage. Efforts to establish DDRT programs are underway but are hampered by the absence of organ procurement systems and insufficient laboratory capabilities. Future priorities include reducing costs and expanded insurance coverage for trans- plant care. Investments in laboratory infrastructure, local tissue typing, and surgical training are essential. Strengthening international collaborations and public education campaigns can improve donor pools and transplantation ac- cess. Strategic policy reforms and resource allocation are vital to scaling up Kenya’s kidney transplant program and addressing the unmet needs of its ESRD population.