Background: Kidney Transplantation is the best treatment for patients in end stage renal disease. It's a new therapeutic approach for such patients in Cote d'Ivoire which is expected to develop. Aim: Determine the adherence factors affecting kidney transplant recipient among patients on maintenance haemodialysis in Cote d'Ivoire and point out possible obstacles to the development of this new practice in the country. Patients and Methods: This was a cross-sectional study carried out from May to June 2016 in the Haemodialysis Centres of Abidjan. Any patient aged ≥18 years, on haemodialysis for at least 6 months, who signed the inform consent were subjected to a questionnaire. None of the respondents had been transplanted. The subjects addressed in the document were sociocultural status, opinion related to kidney transplantation and willingness to be transplanted or not and the reasons. A statistical analysis was performed to determine factors associated with kidney transplantation desire. Results: We included 295 (71.53% males) patients, with a mean age of 44.53 ± 12.09 years. Among this population, 36.61% had a higher level of education, 70.85% were Christians, 66.44% lived with partners, 56.61% had no income and 74.92% were treated in Public Health Centres. The median duration on dialysis was 34 months. A total of 287 (97.29%) patients had already heard of kidney transplantation among which 149 (51.94%) for the first time after initiation of haemodialysis. There was 231 (78.31%) patients willing to be transplanted with only 91 (39.39%) of them having a potential living donors. The main motivations were the desire to stop dialysis (52.38%) and the search for a better quality of life (41.13%). Among the 64 (21.69%) patients unfa- vourable to renal transplantation, 45.31% raised its higher cost compared to haemodialysis. Duration on haemodialysis (>34 months) was significantly higher in patients willing to be transplanted compare to non-applicants (51.95% versus 37.50%, p < 0.04). Factors associated with renal transplantation willingness were younger age (<45 years) (OR = 2.14 CI: 1.12 -4.06 p = 0.02), longer median duration on dialysis (>34 months) (OR = 2.12 CI: 1.15 -3.88 p = 0.01) and the Christian religion (OR = 0.43 CI: 0.20 -0.92 p = 0.03). Conclusion: Almost all patients on maintenance haemodialysis were willing to be transplanted. However, the rate of living donor remains insufficient. For the non-seekers, the high cost of the process remains the main obstacle to kidney transplantation. Transplantation should be given more attention and political support economically by the Government to allow its development in Cote d'Ivoire.

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Quality of life and life span have considerably increased in human immunodeficiency virus (HIV) patients over the past years owing to the highly effective antiretroviral therapy. Consequently, the number of patients with end-stage renal disease (ESRD) has increased in dialysis centers. Several teams in the United States as well as in Europe have therefore proposed renal transplantation to this group of patients with encouraging results. From March 2015 to February 2016, four kidney transplantations have been conducted in the very first kidney transplantation program ever in French speaking black Africa. Three male and one female with a mean age of 50.75 years have been transplanted. One of them was HIV-2 positive. Before kidney transplantation, patients have exhibited diverse highly active antiretroviral therapy (HAART) regimen. They all have undetectable viremia and the mean value of the CD4 count was 454.5 cells/µL. Raltegravir, an integrase inhibitor, has systematically been added to the baseline HAART therapy at least 30 days before transplantation. Immunosuppression comprised basiliximab as induction therapy, tacrolimus, sodium mycophenolate and steroids. After a mean time of six months, all the patients are alive with a mean serum creatinine of 1.425±0.263mg/dl, and a mean proteinuria of 0.55±0.29 g/d. We present these results in full, and discuss them according to data retrieved from the literature. The conditions of access of human immunodeficiency virus positive patients to renal transplantation, the immunosuppression and the antiretroviral regimen, graft and patient survival have all been discussed accordingly.

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