News

Thanks to generous and dedicated support from the Bambino Gesu Children’s Hospital in Italy, the St. John’s Medical College and Hospital in India has now graduated from the ISN-TTS Sister Transplant Centers (STC) Program after completing a fulfilling six-year journey.

The long-term goals of the collaboration were to optimize transplant outcomes and develop a sustainable pediatric renal transplant program in a low-resource setting. These expectations were met and surpassed as the supporting center worked alongside the emerging center to identify and overcome gaps.

The team at the emerging center in India grew in skills and human resources as younger pediatric nephrologists were trained and additional staff recruited to create a multidisciplinary transplant team: two trained transplant coordinators, a dedicated pediatric hemodialysis technician, dietician, and peritoneal dialysis and transplant nurses.

Graduating with honors

During their six years of collaboration, the emerging center had seven transplantrelated papers published; six in peer-reviewed journals and one in a book chapter on pediatric transplantation. The faculty from the emerging center published an invited review on transplantation for the Journal of Paediatric Nephrology and won the ISN-TTS scientific award for the paper presented at IPTA’s 2019 congress. In 2021, they received a grant from the ISN Clinical Research Program for a health-related cost analysis of children with ESKD and transplantation.

Gaps filled, funds raised, leaders emerging

The supporting center in Italy helped identify gaps and challenges in the emerging center’s existing transplant program through mutual visits, discussions, and planning and helped staff there acquire new skills to address challenges relevant to low-resource settings. Access to care, affordability, availability of expertise, and acceptability of modalities of care were key themes considered for the protocols.

The Italian SC’s visits strengthened the EC’s transplant team in India to deliver better immediate outcomes by:

• establishing perioperative, intra-operative and post-operative protocols,
• implementing laparoscopic donor nephrectomy as a regular procedure for all pediatric transplants,
• and assisting with two highly skilled pediatric transplantations, including involving a low body weight patient.

With this collaboration in place, the emerging center found it easier to raise funds to help support kidney transplantation in children from low-resource families,
holding regular annual events to secure donations.

The supporting center helped staff at the Indian center take up leadership roles for the ISN, the International Pediatric Nephrology Association (IPNA), and the International Pediatric Transplant Association (IPTA). These members have since delivered lectures on pediatric transplants in low-resource settings at IPNA and IPTA congresses.

What the future holds

The EC will continue to improve its facilities and initiatives; plans are underway to:

• Hold annual Continuing Medical Education meetings involving the supporting center
• Establish a dependable teleconsultation system to sustain monitoring in case of long-distance travel, an issue in the region
• Develop expertise in renal nutrition to implement within care programs for transplanted children as part of an overall focus on improving their quality of life

The emerging center in India is now considered a center of knowledge, able to support local institutions to advance kidney transplantation in South Asia.