Pediatric Nephrology (2021) 36:693–699

https://doi.org/10.1007/s00467-020-04753-7

ORIGINAL ARTICLE

The current status of kidney transplantation in Nigerian children: still

awaiting light at the end of the tunnel
Felicia U. Eke 1 & Taiwo A. Ladapo 2 & Augustina N. Okpere 1 & Olalekan Olatise 3 & Ifeoma Anochie 1 & Tochi Uchenwa 1 &
Henrietta Okafor 4 & Paul Ibitoye 5 & Uchenna Ononiwu 6 & Ademola Adebowale 7 & Rosamund Akuse 8 & Seyi Oniyangi 6

Received: 24 December 2019 / Revised: 12 May 2020 / Accepted: 14 May 2020 / Published online: 24 September 2020
# IPNA 2020

Abstract
Background Kidney transplantation (KT) is the gold standard treatment for children with chronic kidney disease stage 5 (CKD5).
It is easily accessible in well-resourced countries, but not in low/middle-income countries (LMICs). We present, a multicentre
experience of paediatric KT of children domiciled in Nigeria. We aim to highlight the challenges and ethical dilemmas that
children, their parents or guardians and health care staff face on a daily basis.
Methods A multicentre survey of Nigerian children who received KTs within or outside Nigeria from 1986 to 2019 was
undertaken using a questionnaire emailed to all paediatric and adult consultants who are responsible for the care of children
with kidney diseases in Nigeria. Demographic data, causes of CKD5, sources of funding, donor organs and graft and patient
outcome were analysed. Using Kaplan-Meier survival analysis, we compared graft and patient survival.
Results Twenty-two children, aged 4–18 years, received 23 KTs, of which 12 were performed in Nigeria. The male-to-female
ratio was 3.4:1. Duration of pre-transplant haemodialysis was 4–48 months (median 7 months). Sixteen KTs were self-funded.
State governments funded 3 philanthropists 4 KTs. Overall differences in graft and patient survival between the two groups, log
rank test P = 0.68 and 0.40, respectively were not statistically significant.
Conclusions The transplant access rate for Nigerian children is dismal at < 0.2%. Poor funding is a major challenge. There is an
urgent need for the federal government to fund health care and particularly KTs.

Keywords Kidney transplantation . Nigerian children . Challenges . Funding . Transplant tourism

Electronic supplementary material The online version of this article Introduction

(https://doi.org/10.1007/s00467-020-04753-7) contains supplementary
material, which is available to authorized users. Kidney transplantation (KT) is the gold standard treatment for
children with chronic kidney disease stage 5 (CKD5), with
* Felicia U. Eke
potential for improved quality of life and life expectancy [1,
fellyeke@yahoo.com
2]. In well-resourced countries, there are established national
programmes for renal care including KT for children with
1
University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers CKD5 [2–5]. In contrast, in poorly resourced countries, these
State, Nigeria
programmes of care are minimal or non-existent, and the chal-
2
Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria lenges of KT are vast. Most glaring are the high cost, donor
3
Zenith Medical Centre, Abuja, Federal Capital Territory, Nigeria organ shortage, unavailability of immunosuppressive drugs
4
University of Nigeria Teaching Hospital, Enugu, Enugu State, (IMSD), high cost of IMSD monitoring, lack of infrastructural
Nigeria support and manpower [6–8]. Routinely used IMSDs are
5
Usman Da Fodio University Teaching Hospital, Sokoto, Sokoto methylprednisolone, prednisolone, tacrolimus, basiliximab,
State, Nigeria mycophenolate mofetil and cyclosporine. Whereas predniso-
6
National Hospital, Abuja, Federal Capital Territory, Nigeria lone is readily available in Nigeria, other drugs are usually
7
University College Hospital, Ibadan, Oyo State, Nigeria sourced directly from the pharmaceutical companies through
8 their agents with whom the physicians have direct contact. In
Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
694
some cases, especially when the transplants are performed
overseas, families of patients maintain their links with the
medical teams concerned and are able to procure the medica-
tions from these countries, predominantly India.
In Nigeria, with a population of over 200 million [9], it is
estimated that 7.5 children per million childhood population
annually will develop CKD5 [10, 11]. Unfortunately, as there
is no national programme for renal care services, such as di-
alysis and KT, costs are borne by those who can afford these
services [7, 10]. Poor socioeconomic conditions, political in-
stability and lack of government will are some of the factors
underpinning the health care challenges in our country.
Nigeria has been classified by the United Nations as a low-
middle-income country. The current overall life expectancy at
birth is 54.3 years, and Nigeria ranked 180 out of total 184
listed countries [12]. The under 5 mortality is 119.9/1000 live
births [13], and the average income is $4/day [14], all of which
are reflective of the prevailing health care and economic chal-
lenges. KT is currently the only form of organ transplantation
offered in the country using living relatives as donors as there
is no programme for cadaveric transplants [7]. The first KT in
Nigeria was in an adult in 2000 in a private hospital, following
which over 450 patients have been transplanted in 14 different
centres (Transplant Association of Nigeria Conference, 4–5
August 2019). Four of these centres are privately owned and
have transplanted over 400 adults. There is significantly less
experience with paediatric KT, which constitutes less than 3%
of all transplants carried out to date. Paediatric nephrologists
in Nigeria however continue to offer pre- and post-transplant
care for patients who receive KT outside the country.
Common destinations for KT tourism are India, South
Africa, Tunisia and Pakistan [15].
This paper presents a multicentre experience of paediatric
KT patients in Nigeria with a view to highlight the local chal-
lenges and the ethical dilemmas that children, their parents or
guardians and health care staff face on a daily basis. We be-
lieve that if our experience is not published, we let our patients
down [16]; the status quo will remain and nothing will change
for the children we treat.
Methods
A questionnaire was sent via email to all paediatric and
adult nephrologists and physicians who are responsible
for the care of children with kidney diseases in Nigeria,
requesting information about children domiciled in the
country who had had KT either within or outside
Nigeria and had returned to the country for follow-up.
Information sought included their demographic data,
causes of CKD5, sources of funding and donor organs
and outcome. No patient identifying data was included
in the information collected. Data was analysed using
Pediatr Nephrol (2021) 36:693–699
Microsoft Excel 2016 and the IBM Statistical Package
for Social Sciences Version 24 (IBM Corp. Released
2016. IBM SPSS Statistics for Windows, Version 24.0.
Armonk, NY: IBM Corp). Qualitative data was presented
as percentages, while graft and patient survival were de-
termined using Kaplan-Meier survival analysis. Statistical
significance was set at P value of < 0.05.
Results
Ten paediatricians/physicians submitted data from 8 centres (3
private, 5 government). Of the 14 centres that have performed
KT, 6 had no paediatric KT experience and so had no data to
submit. From 1986 to 2019 (33 years), 22 children (17 males,
5 females) domiciled in Nigeria received 23 KTs of which 12
were performed in Nigeria between 2009 and 2019. The age
range of the children studied was 4–18 years, mean of
13.0 years. The majority (91%) of the KTs performed in
Nigeria were in private hospitals, while only 1 was done in a
teaching hospital. Eleven KTs were performed overseas as
follows: 2 in the USA, 1 in Egypt, and 8 in India. Patient
demographics are as shown in Table 1, while the number of
yearly transplants is depicted in Fig. 1. Thirteen (59.1%) of the
22 children were from the upper social class (social class 1—
top government officials, wealthy royal families, top entrepre-
neurs), 6 (27.3%) from the middle social class (social class
2—top business men, lecturers, public servants) and 3
(13.6%) from the lower social class (social class 3—working
class, petty traders, brick layers).
Pre-transplant Causes of CKD5 were as follows: posterior
urethral valves (PUV) in 6 (27.3%), focal segmental
glomerulosclerosis (FSGS) in 5 (22.7%), sickle cell nephrop-
athy (SCD) in 2 (9.1%), lupus nephritis (LN) in 2 (9.1%),
chronic glomerulonephritis (CGN) in 1 (4.5%) and unknown
in 6 (27.3%). All the patients had haemodialysis (HD), except
for one 4-year-old child transplanted overseas. Time on dial-
ysis varied from 4 to 48 months (median 7 months), as illus-
trated in Table 1. Some patients developed multiple antibodies
presumably from repeated blood transfusions, and one patient
died while waiting for desensitization before he could be of-
fered a second KT.
Funding This is outlined in Table 2. Fifteen patients paid
privately for both the transplant and maintenance therapy. A
state government sponsored the single transplant at a univer-
sity teaching hospital, and the latter funded the immunosup-
pressive drugs for 6 months. Unfortunately, the patient died
from rejection and CKD5, 16 months after the transplant as
the family could not continue to fund the drugs. Three state
governments funded 3 transplants in a private hospital in
2019.
Pediatr Nephrol (2021) 36:693–699 695

Table 1 Paediatric kidney

transplant recipients managed in Year of Age Sex Primary kidney Months on Donor Donor
Nigeria between 1986 and 2019 transplantation diagnosis HD age sex
by year of transplantation, age at
transplantation, gender, 1986 4 F FSGS 0 20 M
underlying diagnosis, months on 2001 12 M PUV 48 36 M
haemodialysis, donor age and sex 2009 12 M U 12 42 M
2009 16 M U 5 45 M
2009 10 M U 10 20 M
2011 9 M U 3 43 M
2011 12 M PUV 6 49 F
2014 16 M SCD 7 38 M
2015 16 F LUPUS 3 43 M
2015 16 M SCD 7 38 M
2015 16 F FSGS 17 42 M
2015 15.5 M PUV 6 45 F
2015 14 M U 7 31 M
2015 14 M U 7 33 M
2017 18 M PUV 10 40 M
2017 13 F FSGS 19 32 M
2018 16 M FSGS 9 35 M
2018 9 M PUV 9 34 M
2018 16 M LUPUS 4 35 M
2019 12 M PUV 4 38 F
2019 9 F FSGS 5 35 F
2019 15 M CGN 7 34 M

FSGS focal segmental glomerulosclerosis, PUV posterior urethral valves, U unknown, SCD sickle cell nephrop-
athy, CGN chronic glomerulonephritis

Donor organs Twenty-two of the 23 KTs were from living- 5 parent donors were mothers, one father agreed to donate
related and non-related donors, but the reluctance of parents to when the mother was found to be medically unfit on screening
donate made finding suitable donors challenging. Four of the and the rest were male-related and non-related donors.

0
1986 1990 2001 2009 2011 2014 2015 2017 2018 2019
Year of Transplant
Fig. 1 No. of transplants per year
696 Pediatr Nephrol (2021) 36:693–699

Table 2 Funding source for

surgery and graft maintenance for Funding source Transplant surgery Maintenance therapy
23 kidney transplants in 22
children Private (personal) 16 15
Philanthropist 1 1
Communal donation 1 1
Government 3 4
Health insurance 0 0
Non-governmental organization 2 2

Outcome Seventeen (77.3%) patients are still alive. The
Kaplan-Meier curves comparing patient and graft surviv-
al between patients transplanted in Nigeria (group 1), and
those transplanted overseas (group 2) are shown in
Fig. 2a, b respectively. Events of interest were patient
death (Fig. 2a) and graft loss (Fig. 2b). Grafts were cen-
sored when they were still functioning, or the patient was
lost to follow-up and patients were categorized as cen-
sored if they were still alive or lost to follow-up. Two
children in group 1 reached the event for graft survival
compared with 5 in group 2. The mean graft survival
times were 7.3 years (95% CI 4.36–10.31) and 8.99 years
(95% CI 4.07–13.91) for groups 1 and 2 respectively.
While 1- and 5-year graft survival rates were similar,
the 10-year graft survival was 82% in group 1 compared
with 40% in group 2. Differences in overall graft surviv-
al between the 2 groups were however not statistically
significant (P = 0.68, log rank test). With regard to pa-
tient survival, 1 and 4 patients reached the event in
groups 1 and 2 respectively. Mean patient survival was
8.58 years (95% CI 6.05–11.12) and 9.22 years (95% CI
4.24–14.21) in groups 1 and 2 respectively. The differ-
ence in patient survival between the 2 groups was also
not statistically significant (P = 0.40, log rank test).
The 1, 5 and 10-year survival rates of patients transplanted
in Nigeria and those transplanted overseas were not
Patient Survival Functions
1.0 Group(No)
1:Nigeria (12)
2:Abroad (10)
1:Censored(11)
0.8
2:Censored(6)
Cummulative Survival
statistically different, as shown in Fig. 2a, b. The longest sur-
vivor had his KT 18 years ago in 2001. Of the 5 deaths, 3 were
from chronic rejection and CKD5 following inability to main-
tain the cost of IMSD and one was from cerebral malaria after
3 years of transplant. The youngest who was transplanted
overseas at the age of 4 years developed depression from
family separation and lost her living-related graft due to
non-adherence. She received a second graft (cadaveric) but
attempted suicide and eventually died from non-adherence
and CKD5 after 6 years of her initial transplant. Chronic re-
jection was diagnosed by kidney biopsy in two patients who
could pay for it. Previously, antibodies were diagnosed by
outside laboratories using CDC Crossmatch and Luminex,
but 1 centre is now equipped to do this.
Two of the KTs performed in a private hospital in Nigeria
were done by the finger-assisted technique which was cheaper
as a laparascope was not needed [17].
Discussion
This multicentre review of Nigerian children with KT aptly
captures the dismal state of paediatric KT in the country. The
incidence of CKD5 in Nigerian children ranges from 4 to 7/
million childhood population per year [10, 11]. Forty-four
percent of Nigeria’s population of > 200 million are aged less
Graft Survival Functions
1.0 Group (No)
1: Nigeria (12)
2: Abroad (11)
1:Censored (10)
0.8
2:Censored (6)

Cummulative Survival

0.6 0.6

0.4 0.4

0.2 0.2

Log-Rank P=0.40 Log-Rank P=0.68

0.0 0.0

.0 5.0 10.0 15.0 20.0 .0 5.0 10.0 15.0 20.0

Years Years

Fig. 2 a Kaplan-Meier curve: patient survival. b Kaplan-Meier curve: graft survival

Pediatr Nephrol (2021) 36:693–699
than 14 years old [9], implying that about 400–500 children
develop CKD5 annually. From our study, 22 children were
transplanted over a period of 33 years (0.67 children/year).
This translates to < 1 child out of the total number with
CKD5/year, giving a transplant access rate of < 0.2%, which
constitutes less than 3% of all transplants done nationally.
This contrasts sharply with well-resourced countries, where
up to 300–800 paediatric transplants are done yearly [15,
16] with access rates often universal for eligible children.
The disparity between adult and paediatric transplant rates is
however universal, with paediatric KT usually constituting a
small fraction (8.3%) of national transplants, e.g. 200 paedi-
atric KT versus 2386 adult KT/year [18, 19], reflective of the
significantly higher prevalence of CKD5 in adults compared
with children [19].
Seventeen of the 22 transplanted children were boys. This
male predominance may reflect cultural preference for boys
among some Nigerians, since earlier studies [10] have not
shown a predominance of males over females with CKD5.
The leading aetiology of CKD5 in this study was PUV, and
its predominance in boys may have contributed to the gender
disparity in our survey. PUV is also the predominant cause of
congenital abnormalities of the kidney and urinary tract
(CAKUT) in our environment [20, 21]. Recent studies on
PUV have shown improved outcome with KT [22]. The sec-
ond leading cause was FSGS, which is the predominant biop-
sy finding in paediatric kidney biopsies in our environment
[23]. No child was diagnosed with primary reflux, as observed
by earlier studies [10]; however, the diagnosis was unknown
in 6 children.
The prolonged stay on maintenance HD before transplan-
tation for most patients was detrimental to their management
as many had repeated blood transfusions and some developed
antibodies with delay in eradication, which led to death in one
patient. Most patients started HD to allow them time to gather
funds for transplantation or because the child presented late
with uraemic symptoms; a few to decide on a donor, as many
parents were reluctant to donate a kidney to their child.
Thirteen of the 22 children (59.1%) were from social class 1,
6 (27.3%) from social class 2 and 3 (13.6%) from social class
3, highlighting the fact that KT was mainly affordable to the
rich. The single death among children transplanted in Nigeria
was from social class 3. Although her KT was funded by the
government and her initial 6-month supply of drugs provided
free by the teaching hospital, the patient could not maintain
her IMSD, emphasizing the need for critical assessment before
a KT. Most parents chose HD instead of peritoneal dialysis
(PD) as they under-dialysed with 1–2 times weekly dialysis
because of financial constraint. Home-based chronic PD is the
universal gold standard for chronic PD with well-established
advantages over HD, including the ability of the child to live a
near normal life [24, 25]. Unfortunately, it is currently un-
available due to the high cost of consumables and an extensive
697
multidisciplinary team requirement [26]. Undoubtedly, any
efforts towards developing an effective national paediatric
KT programme can only be effective if associated with con-
comitant development of chronic PD/HD programmes.
In this study, all donor kidneys in Nigeria were from living
donors. Pre-emptive living donor KT is widely accepted as the
gold standard for kidney replacement therapy and improves
the morbidity and mortality of children with CKD5 [3–5]. The
reluctance of family members, especially males, towards or-
gan donation in this study highlights a fundamental need for
public awareness and education, as these may be linked to
ignorance about living with one kidney, as well as supersti-
tions which are rife in the region. Education is a role for all and
should be taken up by health care organizations, schools, etc.
with relevant bodies such as the Nigerian Association of
Nephrology, Paediatric Nephrology Association of Nigeria
(PNAN) and Transplant Association of Nigeria (TAN) at the
helm of such efforts. Living donor shortage is however uni-
versal; hence, deceased donor organ transplants are well
established in well-resourced countries [1–5]. The latter is
challenging because it involves effective harvesting
programmes and effective referral systems, etc. [25], all of
which may be a mirage for the present in an economically
and politically unstable environment like that which exists in
Nigeria. Nevertheless, the Nigerian Health Bill passed in the
year 2014 contains provisions for both living and deceased
donation in Part VI sections 52–56, and it is hoped that this
will evolve with time.
Funding has been the greatest obstacle to providing KT to
eligible children. It is an unenviable task to decide which child
should be transplanted based solely on financial status. This
has placed a great strain and stress both on parents and carers,
and to date, there is no light at the end of the tunnel [27]. The
children who died because they could not maintain the cost of
IMSD were mainly from social class 3, again highlighting the
questionable debate about transplanting solely on financial
status. Most government hospitals which transplanted adults
between 2000 and 2009 have stopped their programmes be-
cause of poor funding. One new federal government hospital
has recently started KTs and has performed 6 adult KTs in
2 years. The last 2 years has witnessed the stepping in of 3
state governments to aid three children from their state. It is
not known if this was a one-off occurrence or if it heralds a
change of attitude within some sectors of the government. The
reliance on out-of-pocket payment by families thus far severe-
ly restricts access to KT to those who can afford to pay.
PNAN was founded in 2008 to promote knowledge and
communication among paediatricians in paediatric kidney dis-
ease, and to improve care and treatment of childhood kidney
disorders. Following years of effort, the Nigerian Paediatric
Renal Registry was finally launched in September 2019. It is
hoped that this will buttress the efforts of health care providers
in disseminating information on the fate of children with
698
CKD5. Various other local efforts at promoting paediatric KT
include the formation of a Transplant Association of Nigeria
in 2008, Kidney Transplant Advocacy Group in 2016 and
Rekiff Kidney Support Group in 2016.
Our data show that outcomes in children transplanted in
Nigeria are not significantly different from those transplanted
overseas. Several parents chose transplantation overseas be-
cause KT is much cheaper in India than in Nigeria, despite the
extra cost of airfares and accommodation. The disadvantage
of separation from relatives is particularly counterproductive
for children, as highlighted by the case of the child who
attempted suicide while separated from the family. The federal
government has a duty to limit the cost of importation of
several consumables and encourage their home production
to facilitate KT in Nigeria, to alleviate the sufferings of its
nationals and to strengthen local transplantation so that clini-
cal expertise can develop. With the challenges highlighted, we
recommend urgent federal government intervention in
funding health care and particularly KTs. This is truly where
the main challenge lies. Public awareness and education on
organ donation and adherence to long-term maintenance of
IMSD should pave the way for greater success in paediatric
KT in the region.
Acknowledgements We acknowledge the invaluable contributions of
Dr. Valerie Luyckx, Sue Cowley and Ikedi Eke in editing the manuscript.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Ethical approval Ethical approval was not required as this was a ques-
tionnaire survey sent by email to obtain the multicentre experience of a
group of professionals with no direct patient contact at the point of the
survey or use of patient identifying information. As the study spanned
over more than three decades, it was not possible to obtain individual
informed consent from each patient and the authors had agreed as a group
that it was not essential.
References
1. Holmberg C, Jalanko H (2016) Long-term effects of paediatric
kidney transplantation. Nat Rev Nephrol 12:301–311
2. Bonthuis M, Groothoff JW, Ariceta G, Baiko S, Battelino N, Bjerre
A, Cransberg K, Kolvek G, Maxwell H, Miteva P, Molchanova
MS, Neuhaus TJ, Pape L, Reusz G, Rousset-Rouviere C, Sandes
AR, Topaloglu R, Van Dyck M, Ylinen E, Zagozdzon I, Jager KJ,
Harambat J (2019) Growth patterns after kidney transplantation in
European children over the past 25 years: an ESPN/ERA-EDTA
registry study. Transplantation 104:137–144
3. Van Arendonk KJ, Boyarsky BJ, Orandi BJ, James NT, Smith JM,
Colombani PM, Segev DL (2014) National trends over 25 years in
pediatric kidney transplant outcomes. Pediatrics 133:594–601
4. Mumford L, Maxwell H, Ahmad N, Marks SD, Tizard J (2019) The
impact of changing practice on improved outcomes of paediatric
Pediatr Nephrol (2021) 36:693–699
renal transplantation in the United Kingdom: a 25 years review.
Transpl Int 32:751–761
5. Nishimura N, Kasahara M, Ishikura K, Nakagawa S (2017) Current
status of pediatric transplantation in Japan. J Intensive Care 5:48
6. Rizvi SAH, Naqvi SAA, Hussain Z, Hashmi A, Akhtar F, Hussain
M, Ahmed E, Zafar MN, Muzaffar R, Hafiz S (2002) Emerging
challenges in transplantation in developing countries. Transplant
Proc 34:3146–3149
7. Arogundade FA (2011) Kidney transplantation in a low-resource
setting: Nigeria experience. Kidney Int Suppl 3:241–245
8. Yeates K, Ghosh S, Kilonzo K (2013) Developing nephrology pro-
grams in very low-resource settings: challenges in sustainability.
Kidney Int Suppl 3:202–205
9. Nigeria Population (2019) – Worldometers https://www.
worldometers.info › world-population › Nigeria-population.
Accessed Dec 2019
10. Eke F, Eke N (1994) Renal disorders in children. A Nigerian study.
Pediatr Nephrol 8:383–386
11. Asinobi AO, Ademola AD, Ogunkunle OO, Mott SA (2014)
Paediatric end-stage renal disease in a tertiary hospital in South
West Nigeria. BMC Nephrol 15:25–28
12. United Nations Development Program (2018) https://en.wikipedia.
org/wiki/List_of_countries_by_life_expectancy. Accessed 13
Aug 2020
13. World Bank (2018) https://en.wikipedia.org/wiki/List_of_
countries_by_infant_and_under-five_mortality_rates
14. Nigeria Living Wage Individual (2018) https://tradingeconomics.
com/nigeria/living-wage-individual
15. Amira CO, Bello BT (2017) Do the benefits of transplant tourism
amongst Nigerian patients outweigh the risks? A single-Centre ex-
perience. Int J Organ Transplant Med 8:132–139
16. Rees L, Baum M (2019) Writing a paper for publication. Pediatr
Nephrol 34:1307–1309
17. Hakim NS, Papalois V, Canelo R (2008) A fast and safe living
donor ‘finger-assisted’ nephrectomy technique: results of 225
cases. Exp Clin Transplant 6:245–248
18. The UK National Health Service, Blood and Transplant (2017–
2018) Annual Report on Kidney Transplantation. Available at
https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/
12256/nhsbt-kidney-transplantation-annual-report-2017-2018.pdf.
Accessed 30 Nov 2019
19. US Renal Data System (2019) Annual Data Report: Epidemiology
of Kidney Disease in the United States. Executive Summary.
Available at https://www.usrds.org/2019/download/USRDS_
2019_ES_final.pdf. Accesses 30 Nov 2019
20. Ladapo TA, Esezobor CI, Lesi FE (2014) Paediatric nephrology
practice in an African setting: prevalence, spectrum and outcome.
Saudi J Kidney Dis Transpl 25:1110–1116
21. Anigilaje EA, Adesina TC (2019) The pattern and outcomes of
childhood renal diseases at University of Abuja Teaching
Hospital, Abuja, Nigeria: a 4-year retrospective review. Niger
Postgrad Med J 26:53–60
22. McKay AM (2019) Long-term outcome of kidney transplantation
in patients with congenital anomalies of the kidney and urinary
tract. Pediatr Nephrol 34:2409–2415
23. Anochie IC, Eke FU, Okpere AN (2012) Familial FSGS in a
Nigerian family and exclusion of mutations in NPHS2, WT1 and
APOL1 (case report). West Afr J Med 31:273–276
24. Schaefer F, Warady BA (2011) Peritoneal dialysis in children with
end-stage renal disease. Nat Rev Nephrol 27:659–668. https://doi.
org/10.1038/nrneph.2011.135
25. Fraser N, Hussain FK, Connell R, Shenoy MU (2015) Chronic
peritoneal dialysis in children. Int J Nephrol Renov Dis 8:125–
137. https://doi.org/10.2147/IJNRD.S82419
Pediatr Nephrol (2021) 36:693–699 699

26. Girlanda R (2016) Deceased organ donation for transplantation: 54thInauguralLecture-14thDec_2011byProf%28Mrs%29Felici.

challenges and opportunities. World J Transplant 6:451–459. pdf. Accessed 6 Dec 2019
https://doi.org/10.5500/wjt.v6.i3.451
27. Eke F (2006) 54th Inaugural Series, University of Port Harcourt. Publisher’s note Springer Nature remains neutral with regard to jurisdic-
The agony and the Ecstasy of Paediatric Nephrology. 54th Inaugural tional claims in published maps and institutional affiliations.
lecture series, University of Port Harcourt, 2006. https://www.
uniport.edu.ng/files/InauguralLectures/InauguralLecturesUpdated/