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World Kidney Day 2012 focused on transplantation as a therapy for end-stage renal disease but facilities for paediatric transplantation in sub-Saharan Africa are limited. This causes parents of children needing transplantation to seek it elsewhere. Transplant centres must be aware of local issues which affect continuity of care of transplant tourists on return home as illustrated in this report. A 9 year old Nigerian had a live related renal transplant in India. Immunosuppressives were started immediately but they got exhausted after returning home. Financial constraints prevented his parents from obtaining more from India. They were reluctant to buy local drugs because of concerns about quality. Following counseling, he recommenced immunosuppressives. Five days later he developed haematuria. CT scans revealed renal papillary necrosis of the allograft. He improved with antibiotics and intravenous fluids. Clinic attendance and medication adherence were adversely affected by the parents’ belief that transplantation was a cure. Twenty-one months posttransplant, allograft biopsy showed rejection. Because local issues affect care, collaboration between transplant centres, local physicians and international nephrology organizations are needed. Research into factors affecting outcome and strategies to overcome them is required. Meanwhile transplant centres should ensure patients return with six months’ supply of immunosuppressives.

Renal papillary necrosis in a Paediatric Transplant Tourist - The challenge of providing continuity of care