Sickle cell nephropathy is a common presentation in patients with sickle cell disease. End-stage kidney disease is the most severe presentation of sickle cell nephropathy in terms of morbidity and mortality. Sickle cell disease patients with end-stage kidney disease are amenable to renal replacement therapy including kidney transplant. Kidney transplant in these patients has been associated with variable outcome with recent studies reporting short- and long-term outcomes comparable to that of patients with HbAA. Sickle cell disease patients are predisposed to various haematological, cardiorespiratory, and immunological challenges. These challenges have the potential to limit, delay, or prevent kidney transplant in patients with sickle cell disease. There are few reports on the outcome and challenges of kidney transplant in this group of patients. The aim of this review is to highlight the outcome and challenges of kidney transplant in patients with sickle cell disease. 1. Introduction Sickle cell disease (SCD) is a haematological disorder associated with multisystemic complications and manifestations [1]. There had been significant improvement in the outlook of adults with sickle cell disease. The Cooperative Study of Sickle Cell Disease (CSSCD) and other observational studies had helped to define the prognosis and common complications that occur as the patient ages. Improvement in management of infections and central nervous system (CNS) complications in childhood, active health maintenance for adults, new interventions, and improved psychosocial support have all contributed to a reduction in morbidity and mortality. More than 90 percent of patients of all phenotypes will survive for more than 20 years, and significant numbers are older than age of 50 years [1]. Thus, chronic and long-term complications associated with SCD including sickle cell nephropathy/end stage renal disease (ESRD) are becoming common. Treatment of sickle cell nephropathy is fraught with many challenges and has variable outcome. Renal replacement therapy is required in patients with uraemia, circulatory overload, pulmonary oedema, and ESRD. Kidney transplant is the treatment of choice for eligible patients with ESRD. However, kidney transplant is not readily available in most of the developing countries because of cost, poverty, few transplant centres, and lack of donors [2]. SCD and prevailing complications worsen these challenges, further limiting kidney transplant in these patients. The aim of this study is to review the available literature highlighting the outcome and
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