{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:20:28Z","timestamp":1787505628637,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Therapeutic plasma exchange (TPE) is essential for kidney transplant desensitization and management of immune\u2010mediated disorders, yet access remains limited across sub\u2010Saharan Africa due to infrastructure, workforce, and supply chain constraints. While clinical efficacy is well established, there is limited literature describing how such programs can be successfully implemented in resource\u2010constrained environments. This study describes the systematic development, implementation, and operational outcomes of a sustainable TPE program in Nigeria, with emphasis on practical strategies for replication. We conducted a mixed\u2010methods evaluation combining program development analysis (2017\u20132023) with retrospective clinical data review of all TPE procedures performed between January 2020 and December 2022. Key domains analyzed included infrastructure development, equipment procurement, staff training, protocol adaptation, quality assurance systems, cost structure, and operational challenges. Clinical outcomes included utilization patterns and safety metrics. Program establishment required approximately 24\u2009months and an initial capital investment of $148\u2009000 USD. A total of 150 TPE sessions were performed in 90 patients. The predominant indication was pretransplant desensitization, followed by antibody\u2010mediated rejection, T\u2010cell mediated rejection, and Guillain\u2013Barr\u00e9 syndrome. Procedure\u2010related complications occurred in 2% of sessions and were uniformly mild and reversible, with no mortality. Direct cost per procedure decreased from $685 in 2020 to $550 in 2022, achieving financial sustainability by the third year of operation. Key operational challenges included supply chain delays, power instability, and workforce retention, which were mitigated through structured adaptations including long\u2010term inventory planning, infrastructure redundancy, and staff development strategies. TPE programs can be safely and sustainably established in resource\u2010constrained settings through structured planning, context\u2010specific adaptations, and investment in local capacity building. Transplant outcomes were not analyzed in this study period. This experience provides a practical and replicable framework for expanding access to apheresis services in similar environments.<\/jats:p>","DOI":"10.1002\/jca.70137","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T04:31:55Z","timestamp":1780288315000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Establishing a Safe and Effective Therapeutic Plasma Exchange Program in a Resource\u2010Constrained Transplant Center: A 6\u2010Year Nigerian Experience"],"prefix":"10.1002","volume":"41","author":[{"given":"Ade E.","family":"Faponle","sequence":"first","affiliation":[{"name":"Department of Medicine Zenith Medical and Kidney Center  Abuja Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayoola","family":"Odeyemi","sequence":"additional","affiliation":[{"name":"Department of Medicine Zenith Medical and Kidney Center  Abuja Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olalekan","family":"Olatise","sequence":"additional","affiliation":[{"name":"Department of Medicine Zenith Medical and Kidney Center  Abuja Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasheed A.","family":"Balogun","sequence":"additional","affiliation":[{"name":"Division of Nephrology University of Virginia  Charlottesville Virginia USA"},{"name":"Department of Pathology University of Virginia  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3565(25)08256-4"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12629"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21470"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21705"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1155\/2010\/501957"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30057-8"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv466"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp058318"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(12)80135-1"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20039"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.2920090102"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2008.02.360"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1744-9987.12549"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012376"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181d21e7f"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70137","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jca.70137","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70137","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T07:16:15Z","timestamp":1782458175000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.70137"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,31]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/jca.70137"],"URL":"https:\/\/doi.org\/10.1002\/jca.70137","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"value":"0733-2459","type":"print"},{"value":"1098-1101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,31]]},"assertion":[{"value":"2026-02-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70137"}}