Pediatric Transplantation. 2020;00:e13644. wileyonlinelibrary.com/journal/petr | 1 of 9 https://doi.org/10.1111/petr.13644 © 2020 Wiley Periodicals, Inc. Received: 3 June 2019 | Revised: 1 October 2019 | Accepted: 29 November 2019 DOI: 10.1111/petr.13644 ORIGINAL ARTICLE Contemporary outcomes of the pediatric kidney transplant program in Johannesburg, South Africa, between 2004 and 2017: Better or not—And which way forward? Cleopatra N. Mshumpela 1 | Jerome Loveland 1,2 | Rene Botha 2 | Russel Britz 2 | Cecil Levy 3 | Heather Maher 2 | Aletha Withers 1 | June Fabian 2,4 | Jean Botha 2 This paper forms part of the requirements to fulfill an MMed (pediatric surgery) degree for C Mshumpela, supervised by June Fabian and Jerome Loveland. Abbreviations: CAKUT, congenital anomalies of the kidney and urinary tract; CMJAH, Charlotte Maxeke Johannesburg Academic Hospital; DD, deceased donor; ESKD, end-stage kidney disease; FSGS, focal segmental glomerulosclerosis; HIC, high-income country; HLA, human leukocyte antigen; HR, hazards ratio; KA, kidney-alone; LD, living donor; LMIC, low- and middle-income country; REDCap, Research Electronic Data Capture; RLD, related living donor; RRT, renal replacement therapy; UMIC, upper middle-income country; WDGMC, Wits Donald Gordon Medical Centre; WITS, University of Witwatersrand. 1 Department of Pediatric Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 2 Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa 3 Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa 4 Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Correspondence Cleopatra N. Mshumpela, 83 Buckingham Road, Craighall Park, Randburg 2196, South Africa. Email: cmshumpela@yahoo.com Funding information Wits Donald Gordon Medical Centre funded the statistical analysis. Abstract Background: Outcomes for the pediatric kidney transplant program in Johannesburg (1984-2003) were found to be suboptimal. In this study, we compared (a) early (era 1:1984-2003) to contemporary (era 2:2004-2017) outcomes and (b) compared con- temporary outcomes between the public and private sector hospitals in our program. Methods: We conducted a retrospective record review of all pediatric (<18 years) KA transplants performed in our kidney transplant program at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC) from 2004 to 2017. We collected the following data per site: number of recipients, transplants performed, mean follow-up time, and grafts lost; per recipi- ent: age at time of transplant, sex, self-reported population group; transplant history; donor type; etiology of ESKD; recipient and graft survival. Outcomes for era 1 were based on data published on our kidney transplant program, based at CMJAH. Results: At CMJAH (public sector), there was no improvement in recipient and graft survival over time. In the contemporary analysis, 1-, 5-, and 10-year recipient sur- vival, as % (95% CI) was 93 (84-97); 76 (64-84); 59 (44-70) for CMJAH, and 98 (90-99); 95 (86-99); 82 (54-94) for WDGMC (private sector). Similarly, 1-, 5- and 10-year graft survival was 75 (63-84); 55 (42-66); 36 (24-49) for CMJAH, and 96 (87-99); 84 (73- 91); 64 (48-76) at WDGMC. Conclusion: Contemporary outcomes for the pediatric kidney transplant program at WDGMC are comparable to outcomes achieved in middle- and high-income settings. However, outcomes at CMJAH are suboptimal, reflecting numerous health system, infrastructural and human resource challenges. KEYWORDS kidney, pediatric, recipient and graft survival, South Africa, transplantation