Establishing a kidney transplant program in a post-conflict region: The initial experience of Ibn Sina Teaching Hospital in Sirte, Libya

Background: Kidney transplantation remains the preferred treatment modality for patients with end-stage kidney disease (ESKD). However, establishing kidney transplant programs in developing and post-conflict regions remains highly challenging because of infrastructure limitations, shortages in trained personnel, financial constraints, and limited immunological support systems. In September 2025, a collaborative initiative between Ibn Sina Teaching Hospital in Sirte, Libya, and the Arab Renal Care Group (ARCG), Jordan, led to the establishment of a structured living-related kidney transplant program in central Libya.
Methods: A multidisciplinary transplant system was developed through extensive pre-implementation strategic planning, including virtual meetings, protocol development, infrastructure evaluation, staff training, immunological preparation, and postoperative care planning. The program included nephrologists, transplant surgeons, vascular surgeons, ICU physicians, transplant coordinators, nursing staff, immunology laboratories, and dialysis support services. Patients underwent immunological risk stratification and standardized recipient evaluation according to internationally accepted transplant principles and KDIGO/KDOQI-based recommendations.
Results: Up to the time of this report, 34 kidney transplants had been successfully performed. Follow-up duration ranged between four weeks and seven months, with the majority of recipients followed for more than three months. Complications included one major urinary leak requiring reconstruction, one minor urinary leak, one biopsy-proven acute cellular rejection episode, and one delayed graft function episode likely secondary to acute tubular necrosis caused by prolonged ischemic time during surgery. The latter patient required one hemodialysis session before complete renal recovery and discharge with normal graft function. High-risk recipients received anti-thymocyte globulin induction therapy, while moderate- to low-risk recipients received basiliximab induction therapy. All patients continued on tacrolimus-based maintenance immunosuppression. Progressive transfer of knowledge and local empowerment resulted in the final six transplant procedures being performed predominantly by Libyan physicians and healthcare teams.
Conclusion: The successful establishment of a kidney transplant program at Ibn Sina Teaching Hospital demonstrates that advanced transplant services can be developed in resource-limited and post-conflict environments through structured planning, international collaboration, and progressive local capacity building. The experience highlights the importance of education, multidisciplinary coordination, and sustainable knowledge transfer in establishing long-term transplant programs.