CHAPTER 5
RENAL TRANSPLANTATION
Editor: Dr Goh Bak Leong
Expert Panel: Dr Goh Bak Leong Chair
Fan Kin Sing Rohan Malek Bin Dato’ Dr. Johan
Rosnawati Yahya S. Prasad Menon
Tan Si Yen Wong Hin Seng
Contents 5.1 Stock and Flow of Renal Transplantation
• Stock and Flow • Transplant Rates
5.2 Recipients’ Characteristics
• Demographics, Clinical and Serology Status
• Primary Causes of ESRF 5.3 Transplant Practices
• Type of Transplant • Place of Transplant
5.4 Transplant Outcomes
• Post Transplantation Complications • Biochemical Outcome
• Deaths and Graft Loss
5.5 Patient and Graft Survival 5.6 Use of Immunosuppression and Non Immunosuppressive Medications
5.7 Cardiovascular Risk in Renal Transplant Recipients 5.8 Influence of Immunosuppression on Outcome and Cardiovascular Risk Factors
5.9 QoL Index Score in Renal Transplant Recipients
List of Tables Chapter
Table of Listing Page
Table 5.1.1 Stock and flow of renal transplantation, 1993-2012
5 Table 5.1.2
New transplant rate per million populations pmp, 1993-2012 6
Table 5.1.3 Transplant prevalence rate per million population, 1993-2012
6 Table 5.2.1
Renal transplant recipients’ characteristics, 1993-2012 7
Table 5.2.2 Primary causes of end stage renal failure, 1993-2012
8 Table 5.3.1
Type of renal transplantation, 1993-2012 9
Table 5.3.2 Place of transplantation, 1993-2012
10 Table 5.4.1
Post-transplant complications, 1993-2012 12
Table 5.4.2 Biochemical data, 2004-2012
13 Table 5.4.3
Transplant patients’ death rate and graft loss, 1993-2012 15
Table 5.4.4a Causes of death in transplant recipients, 1993-2012
16 Table 5.4.4b
Causes of graft failure, 1993-2012 17
Table 5.5.1.1 Patient survival, 1993-2012
19 Table 5.5.1.2
Risk factors for transplant patient survival 1993-2012 19
Table 5.5.1.3 Graft survival, 1993-2012
20 Table 5.5.1.4
Risk factors for transplant graft survival 1993-2012 21
Table 5.5.2.1 Unadjusted patient survival by type of transplant, 1993-2012
22 Table 5.5.2.2
Graft survival by type of transplant, 1993-2012 23
Table 5.5.3.1 Patient survival by year of transplant Living related transplant,
1993-2012 24
Table 5.5.3.2 Graft survival by year of transplant Living related transplant,
1993-2012 25
Table 5.5.4.1 Patient survival by year of transplant Commercial cadaver
transplant, 1993-2012 26
Table 5.5.4.2 Graft survival by year of transplant Commercial cadaver
transplant, 1993-2012 27
Table 5.6.1 Medication data, 2004-2012
29 Table 5.6.2
Use of anti-hypertensive medication 31
Table 5.7.1 Risk factors for IHD in renal transplant recipients at year
2004-2012 32
Table 5.7.2a Systolic BP, 2004-2012
34 Table 5.7.2b
Diastolic BP, 2004-2012 35
Table 5.7.3 CKD stages, 2004-2012
36 Table 5.7.4
BMI, 2004-2012 37
Table 5.7.5a LDL choelsterol, 2004-2012
38 Table 5.7.5b
Total cholesterol, 2004-2012 39
Table 5.7.5c HDL cholesterol, 2004-2012
40 Table 5.7.6a
Treatment for hypertension, 2004-2012 41
Table 5.7.6b Distribution of systolic BP without anti-hypertensive, 2004-2012
41 Table 13.7.6c
Distribution of diastolic BP without anti-hypertensive, 2004-2012 41
Table 5.7.6d Distribution of systolic BP on anti-hypertensives, 2004-2012
41 Table 5.7.6e
Distribution of diastolic BP on anti-hypertensives, 2004-2012 42
Table 5.8.1 Allograft and patient survival, Azathioprine vs Mycophenolic
Acid 1993-2012 42
Table 5.8.2 Graft and patient survival, CsA vs Tacrolimus
43 Table 5.8.3
Mean SBP, CsA vs Tacrolimus, 2004-2012 44
Table 5.8.4 Mean GFR, CsA vs Tacrolimus, 2004-2012
45
3
List of Tables cont’
Chapter Table of Listing
Page Table 5.8.5
Mean LDL cholesterol, CsA vs Tacrolimus, 2004-2012 45
Table 5.8.6 Incidence of post transplant diabetes mellitus,
CsA vs Tacrolimus, 2004-2012 46
Table 5.9.1 Cumulative distribution of QoL-Index score transplant recipient
patients 1993-2012 47
Table 5.9.2 Cumulative distribution of QoL-Index score in relation to diabetes
mellitus, transplant recipient patients 1993-2012 48
Table 5.9.3 Cumulative distribution of QoL-Index score in relation to gender,
transplant recipient patients 1993-2012 48
Table 5.9.4 Cumulative distribution of QoL-Index score in relation to age,
transplant recipient patients 1993-2012 49
Table 5.9.5 Cumulative distribution of QoL-Index score in relation to year of
entry, transplant recipient patients 1993-2012 50
List of Figures Figure
Label Page
Figure 5.1.1 Stock and flow of renal transplantation, 1993-2012
5 Figure 5.1.2
New transplant rate, 1993-2012 6
Figure 5.1.3 Transplant prevalence rate, 1993-2012
7 Figure 5.4.3a
Transplant recipient death rate, 1993-2012 15
Figure 5.4.3b Transplant recipient graft loss rate, 1993-2012
16 Figure 5.5.1.1
Patient survival, 1993-2012 19
Figure 5.5.1.3 Graft survival, 1993-2012
20 Figure 5.5.2.1
Patient survival by type of transplant, 1993-2012 22
Figure 5.5.2.2 Graft survival by type of transplants, 1993-2012
23 Figure 5.5.3.1
Patient survival by year of transplant Living related transplant, 1993-2012
24 Figure 5.5.3.2
Graft survival by year of transplant Living related transplant, 1993-2012
25 Figure 5.5.4.1
Patient survival by year of transplant Commercial cadaver transplant, 1993-2012
26 Figure 5.5.4.2
Graft survival by year of transplant Commercial cadaver transplant, 1993-2012
27 Figure 5.6.1ai Calcineurin inhibitors: Cyclosporin vs Tacrolimus
30 Figure 5.6.1aii Antimetabolites: Azathioprine vs Mycophenolic Acid
30 Figure 5.7.1a
Venn diagram for pre and post transplant complications at year 2004
32 Figure 5.7.1b
Venn diagram for pre and post transplant complications at year 2006
33 Figure 5.7.1c
Venn diagram for pre and post transplant complications at year 2008
33 Figure 5.7.1d
Venn diagram for pre and post transplant complications at year 2010
33
4
List of Figures cont’
Figure Label
Page Figure 5.7.1e
Venn diagram for pre and post transplant complications at year 2012
34 Figure 5.7.2a
Systolic BP, 2004-2012 35
Figure 5.7.2b Diastolic BP, 2004-2012
36 Figure 5.7.3
CKD stages by year 37
Figure 5.7.4 BMI, 2004-2012
38 Figure 5.7.5a
LDL cholesterol, 1993-2012 39
Figure 5.7.5b Total cholesterol, 2004-2012
39 Figure 5.7.5c
HDL cholesterol, 2004-2012 40
Figure 5.8.1a Graft survival, Azathioprine vs Mycophenolic Acid 1993-2012
42 Figure 5.8.1b
Patient survival, Azathioprine vs Mycophenolic Acid, 1993-2012 43 Figure 5.8.2a
Graft survival, CsA vs Tacrolimus, 1993-2012 44
Figure 5.8.2b: Patient survival, CsA vs Tacrolimus, 1993-2012 44
Figure 5.8.3 Mean SBP, CsA vs Tacrolimus, 2004-2012
44 Figure 5.8.4:
Mean GFR, CsA vs Tacrolimus, 2004-2012 45
Figure 5.8.5 Mean LDL cholesterol, CsA vs Tacrolimus, 1993-2012
46 Figure 5.8.6
Cumulative incidence of post transplant diabetes, CsA vs Tacrolimus, 2004-2012
46 Figure 5.9.1
Cumulative distribution of QoL-Index score transplant recipient patients 1993-2012
47 Figure 5.9.2
Cumulative distribution of QoL-Index score in relation to diabetes mellitus, transplant recipient patients 1993-2012
48 Figure 5.9.3
Cumulative distribution of QoL-Index score in relation to gender, transplant recipient patients 1993-2012
49 Figure 5.9.4
Cumulative distribution of QoL-Index score in relation to age, transplant recipient patients 1993-2012
50 Figure 5.9.5
Cumulative distribution of QoL-Index score in relation to year of entry, transplant recipient patients 1993-2012
50
5
5.1 STOCK AND FLOW
