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Background <p>Infectious complications remain the leading cause of morbidity and mortality in kidney transplant recipients (KTRs) across Africa, where immunosuppression is delivered amid endemic pathogens, resource constraints, and limited microbiological surveillance. These challenges are compounded by near-universal cytomegalovirus (CMV) seropositivity, high tuberculosis burden, and constrained access to standard prophylactic antivirals.</p> Objectives <p>To synthesize evidence on the epidemiology, microbiology, and management of infectious complications in African KTRs, with emphasis on context-adapted prophylaxis strategies and systemic gaps.</p> Methods <p>This scoping review searched PubMed and African Journals Online (2015–2025) for primary cohort studies, systematic reviews, and clinical trials published between 2015 and 2025 reporting infection outcomes in African KTRs, supplemented by global evidence on CMV prophylaxis in resource-limited settings. Foundational studies predating 2015 were included where no more recent equivalent existed. This review was conducted following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Studies were eligible if they reported infection outcomes in African kidney transplant recipients. Data were charted descriptively by infection type, country, and prophylaxis strategy.</p> Results <p>Bacterial urinary tract infections predominate early post-transplant, with Escherichia coli causing up to 54% of cases. CMV infection occurs in 13–63% of seropositive recipients despite prophylaxis, with rates varying by regimen and monitoring intensity; tissue-invasive disease is associated with acute rejection rates approaching 50%. Low-dose valacyclovir shows encouraging prophylactic efficacy comparable to valganciclovir at approximately one-sixth the cost, suggesting it may represent a pragmatic alternative in resource-limited African settings where valganciclovir is unavailable or unaffordable. Pediatric transplantation remains severely underdeveloped across sub-Saharan Africa, compounded by weight-based CMV dosing challenges and absent dedicated pediatric units. Critical systemic gaps, nephrology workforce deficits, and near-total absence of transplant infectious disease subspecialty training perpetuate high infectious morbidity after transplantation.</p> Conclusions <p>Improving outcomes will require evaluation of cost-effective prophylaxis protocols through prospective multicenter registries, alongside urgent investment in transplant infectious disease workforce capacity.</p>

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Infectious complications in kidney transplant recipients across Africa: a scoping review of epidemiology, microbiology, and prophylaxis strategies

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月21日

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  • Sabastine Eugene Arthur,
  • AnneMarie Sankofi,
  • Michella Naa Awula Atswei Laryea,
  • Richeal Owusu,
  • James Odame Aboagye,
  • Catherine Laaripuoh Omosule,
  • George Boateng Kyei

摘要

Background

Infectious complications remain the leading cause of morbidity and mortality in kidney transplant recipients (KTRs) across Africa, where immunosuppression is delivered amid endemic pathogens, resource constraints, and limited microbiological surveillance. These challenges are compounded by near-universal cytomegalovirus (CMV) seropositivity, high tuberculosis burden, and constrained access to standard prophylactic antivirals.

Objectives

To synthesize evidence on the epidemiology, microbiology, and management of infectious complications in African KTRs, with emphasis on context-adapted prophylaxis strategies and systemic gaps.

Methods

This scoping review searched PubMed and African Journals Online (2015–2025) for primary cohort studies, systematic reviews, and clinical trials published between 2015 and 2025 reporting infection outcomes in African KTRs, supplemented by global evidence on CMV prophylaxis in resource-limited settings. Foundational studies predating 2015 were included where no more recent equivalent existed. This review was conducted following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Studies were eligible if they reported infection outcomes in African kidney transplant recipients. Data were charted descriptively by infection type, country, and prophylaxis strategy.

Results

Bacterial urinary tract infections predominate early post-transplant, with Escherichia coli causing up to 54% of cases. CMV infection occurs in 13–63% of seropositive recipients despite prophylaxis, with rates varying by regimen and monitoring intensity; tissue-invasive disease is associated with acute rejection rates approaching 50%. Low-dose valacyclovir shows encouraging prophylactic efficacy comparable to valganciclovir at approximately one-sixth the cost, suggesting it may represent a pragmatic alternative in resource-limited African settings where valganciclovir is unavailable or unaffordable. Pediatric transplantation remains severely underdeveloped across sub-Saharan Africa, compounded by weight-based CMV dosing challenges and absent dedicated pediatric units. Critical systemic gaps, nephrology workforce deficits, and near-total absence of transplant infectious disease subspecialty training perpetuate high infectious morbidity after transplantation.

Conclusions

Improving outcomes will require evaluation of cost-effective prophylaxis protocols through prospective multicenter registries, alongside urgent investment in transplant infectious disease workforce capacity.