Biochemical outcome Table : Biochemical data, 2004-2012

13 5.4.2 Biochemical outcome Table 5.4.2: Biochemical data, 2004-2012 Biochemical parameter Summary 2004 2005 2006 2007 2008 2009 2010 2011 2012 Creatinine umolL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 131.9 133.6 134.4 130.5 131.2 128.1 129.7 126.9 129 SD 63.8 65.4 73.7 69.3 76.6 62.8 79.7 74.1 82.4 Median 120 120 120 116 115 115 112 111 110 Minimum 38 35 21.7 36 29 10.7 10.3 10.1 12 Maximum 817 763 970 922 898 657 882 970 1000 Hb gdL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 12.9 12.8 12.7 12.8 12.8 12.6 12.6 12.6 12.7 SD 1.9 1.9 1.9 1.9 1.9 1.8 1.9 1.8 1.8 Median 12.9 12.9 12.8 12.8 12.7 12.7 12.7 12.7 12.7 Minimum 4.9 5.5 3.3 4.4 6.2 5.3 1.8 4.5 1.8 Maximum 19.7 19 19.8 18.7 18.6 18.5 18.5 18.9 18.8 Albumin gL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 39.8 39.9 39.9 39.9 39.9 39.8 39.9 39.8 40 SD 1 0.5 0.7 0.8 0.8 1.3 1.4 1.2 1.1 Median 39.9 39.9 39.9 39.9 39.9 39.9 39.9 39.9 39.9 Minimum 22 34 29 29 30 21 24 19 26 Maximum 50 46 48 48 50 50 75 49.8 53 Calcium mmolL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 2.4 2.3 2.3 2.3 2.3 2.3 2.3 2.3 2.3 SD 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 Median 2.3 2.3 2.3 2.3 2.3 2.3 2.3 2.3 2.3 Minimum 1.1 1.2 1.1 1.4 1 1.1 1.1 1 1.3 Maximum 3.3 3.3 3.1 3.2 3.5 3.3 3.2 4 3.8 Phosphate mmolL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 SD 0.2 0.2 0.2 0.3 0.3 0.2 0.3 0.2 0.2 Median 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 1.1 Minimum 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 Maximum 2.7 3.3 3.5 3.9 3.2 2.8 3.1 3 3.9 Alkaline phosphate UL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 79.8 79.1 79.2 79.5 79 80 82.6 81.3 82.4 SD 46.3 46.5 43.2 39.8 46.4 45.3 58.6 42.6 42.6 Median 73 73 71 72.5 72 73 73 73 75 Minimum 20 20 24 22 20 21 20 21 21 Maximum 994 831 700 508 985 732 964 650 716.8 ALT UL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 31.3 30.6 29.8 29.8 30 29.8 27.1 26.6 26.6 SD 32.6 31 30.4 25.6 37.8 32.5 25.1 22 18.7 Median 25 24 22 23 23 24 21 21.2 23 Minimum 4 4 4 4 4 4 4 4 4 Maximum 563 613 433 356 881 881 410 371 205 Total cholesterol mmolL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 5.5 5.3 5.3 5.2 5.7 5.2 5.2 5.1 5.3 SD 1.1 1 1.1 1 12.3 1.5 1.5 1.1 2.5 Median 5.3 5.3 5.3 5.3 5.3 5.3 5.3 5.2 5.2 Minimum 1.8 1 1.3 1.7 2 0.7 1.3 1 0.9 Maximum 20 13.1 14.7 11.4 490 46 49 14.9 63 14 Biochemical parameter Summary 2004 2005 2006 2007 2008 2009 2010 2011 2012 LDL mmolL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 3.1 3 3 2.9 2.9 2.8 2.9 2.9 2.9 SD 0.7 0.8 0.8 0.8 0.8 1 0.9 0.8 0.8 Median 2.9 2.9 2.9 2.9 2.9 2.9 2.9 2.9 2.9 Minimum 1 0.9 1 1 0.9 0.9 0.9 1 0.9 Maximum 8.5 9.2 11.1 8.9 7.7 10.8 10.4 12.2 9.9 HDL mmolL n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 1.6 1.6 1.6 1.5 1.6 1.5 1.5 1.5 1.5 SD 0.4 0.5 0.5 0.4 0.5 0.5 0.5 0.5 0.4 Median 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 Minimum 0.4 0.4 0.4 0.4 0.5 0.4 0.4 0.5 0.5 Maximum 4.3 5.6 5.8 7.5 7.5 6.9 6.8 9 5 Systolic BP mmHg n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 132.2 133.3 130.7 131.6 129.4 130.1 129.7 130.1 130.5 SD 15.9 16.9 15.9 15.7 15.3 14.7 14.8 15.3 13.3 Median 130 130 130 130 130 130 130 130 130 Minimum 80 80 66 80 80 65 70 71 91.3 Maximum 200 220 210 210 245 210 192 200 203.8 Diastolic BP mmHg n 1550 1635 1592 1688 1698 1695 1831 1905 1892 Mean 80.3 80.5 78.9 78.7 77.5 78.2 77.4 77.7 77.9 SD 9.6 9.2 9.8 9.4 9.2 8.7 9.4 9.2 8 Median 80 80 80 80 78.5 79 78.5 80 78.5 Minimum 40 50 30 20 20 40 10 30 46 Maximum 121 127 120 116 133 120 124 114 118.5 5.4.3 Deaths and Graft loss In 2012, 45 transplant recipients died and 41 lost their grafts. The rates of transplant death and grafts lost have remained static for the past 20 years Table 5.4.3 despite advances in immunosuppression and antibiotics. The main causes of death have consistently been infection and cardiovascular disease with 35 and 22 respectively. In the last 2 years, the proportion of patient who died at home, which is usually presumed to be cardiovascular death, has increased to 17. Cancer death rates have been significantly high from 2002 to 2012 contributing between 8 to 17 of all deaths. Death due to liver disease has slowly declined from 13 in 2002 to around 4 in the last few years. Rejection remains the major cause of graft loss. 15 Table 5.4.3: Transplant patients’ death rate and graft loss, 1993-2012 Year 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Number at risk 734 809 914 988 1064 1110 1155 1225 1304 1394 Transplant death 24 30 17 37 32 28 29 32 40 38 Transplant death rate 3.3 3.7 1.9 3.7 3 2.5 2.5 2.6 3.1 2.7 Graft loss 20 22 27 24 35 48 36 30 39 33 Graft loss rate 2.7 2.7 3 2.4 3.3 4.3 3.1 2.4 3 2.4 Acute rejection 1 Acute rejection rate 0.1 All losses 44 52 44 61 67 76 65 62 79 71 All losses rate 6 6.4 4.8 6.2 6.3 6.8 5.6 5.1 6.1 5.1 Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Number at risk 1481 1569 1666 1741 1776 1794 1825 1861 1884 1893 Transplant death 41 44 48 58 47 59 49 47 54 45 Transplant death rate 2.8 2.8 2.9 3.3 2.6 3.3 2.7 2.5 2.9 2.4 Graft loss 41 43 21 36 36 39 37 46 42 41 Graft loss rate 2.8 2.7 1.3 2.1 2 2.2 2 2.5 2.2 2.2 Acute rejection 4 19 14 19 14 24 32 81 53 20 Acute rejection rate 0.3 1.2 0.8 1.1 0.8 1.3 1.8 4.4 2.8 1.1 All losses 82 87 69 94 83 98 86 93 96 86 All losses rate 5.5 5.5 4.1 5.4 4.7 5.5 4.7 5 5.1 4.5 Graft loss=graft failure All losses=death graft loss acute rejection happens concurrently with graft failure death .5 1 1.5 2 2.5 3 3.5 D e a th r a te 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 Year Annual death rate Figure 5.4.3a: Transplant recipient death rate, 1993-2012 16 .5 1 1.5 2 2.5 3 3.5 4 4.5 G ra ft l o s s r a te 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 Year Annual graft loss rate Figure 5.4.3b: Transplant recipient graft loss rate, 1993-2012 5.4.4 Causes of death and graft loss Table 5.4.4 a: Causes of death in transplant recipients, 1993-2012 Year 1993 1994 1995 1996 1997 n n n n n Cardiovascular 4 16 5 16 8 44 4 11 4 12 Died at home 3 12 1 6 3 8 2 6 Infection 8 32 19 61 3 17 19 50 15 45 Graft failure Cancer 1 4 1 6 2 5 Liver disease 1 4 1 3 1 6 3 8 2 6 Accidental death 1 6 Others 3 10 1 6 1 3 2 6 Unknown 8 32 3 10 2 11 6 16 8 24 TOTAL 25 100 31 100 18 100 38 100 33 100 Year 1998 1999 2000 2001 2002 n n n n n Cardiovascular 4 14 6 18 10 29 7 15 6 15 Died at home 4 14 6 18 1 3 5 11 5 13 Infection 10 34 7 21 12 34 22 48 14 35 Graft failure Cancer 3 10 3 9 2 6 7 15 5 13 Liver disease 2 7 3 9 1 3 2 4 5 13 Accidental death 1 3 1 3 1 2 1 3 Others 2 7 4 12 3 9 2 5 Unknown 4 14 4 12 5 14 2 4 2 5 TOTAL 29 100 34 100 35 100 46 100 40 100 17 Year 2003 2004 2005 2006 2007 n n n n n Cardiovascular 14 30 6 13 5 10 13 21 10 20 Died at home 5 11 5 11 6 12 7 11 5 10 Infection 13 28 17 36 29 58 25 40 19 37 Graft failure Cancer 7 15 8 17 5 10 5 8 6 12 Liver disease 3 7 4 9 3 6 5 8 Accidental death 1 2 1 2 1 2 Others 1 2 3 6 2 3 1 2 Unknown 2 4 4 9 1 2 5 8 10 20 TOTAL 46 100 47 100 50 100 63 100 51 100 Year 2008 2009 2010 2011 2012 n n n n n Cardiovascular 12 22 13 25 10 17 8 17 12 22 Died at home 9 17 7 13 5 8 8 17 9 17 Infection 19 35 16 30 21 36 18 39 19 35 Graft failure Cancer 7 13 6 11 5 8 4 9 7 13 Liver disease 2 4 2 4 2 3 3 7 2 4 Accidental death Others 1 2 4 8 7 12 2 4 1 2 Unknown 4 7 5 9 9 15 3 7 4 7 TOTAL 54 100 53 100 59 100 46 100 54 100 Table 5.4.4b: Causes of graft failure, 1993-2012 Year 1993 1994 1995 1996 1997 n n n n n Rejection acutechronic 9 45 10 40 15 54 10 40 17 49 Calcineurin toxicity 2 10 1 4 Other drug toxicity 1 3 Ureteric obstruction 1 4 1 4 Infection 1 4 Vascular causes 1 5 1 4 1 4 1 4 4 11 Recurrent de novo renal disease 1 5 2 8 2 8 1 3 Others 1 4 1 4 5 14 Unknown 7 35 9 36 10 36 11 44 7 20 TOTAL 20 100 25 100 28 100 25 100 35 100 Year 1998 1999 2000 2001 2002 n n n n n Rejection acutechronic 28 54 22 61 18 60 24 60 19 56 Calcineurin toxicity 1 3 Other drug toxicity Ureteric obstruction Infection 1 2 2 5 Vascular causes 2 4 1 3 3 10 1 3 Recurrent de novo renal disease 1 2 2 5 2 6 Others 5 10 2 7 2 6 Unknown 15 29 13 36 7 23 11 28 10 29 TOTAL 52 100 36 100 30 100 40 100 34 100 18 Year 2003 2004 2005 2006 2007 n n n n n Rejection acutechronic 20 47 29 67 15 68 25 68 24 67 Calcineurin toxicity 1 2 Other drug toxicity Ureteric obstruction 1 3 Infection 2 5 1 2 1 5 2 5 1 3 Vascular causes 3 7 4 9 2 9 4 11 1 3 Recurrent de novo renal disease 2 5 1 2 1 3 Others 1 2 1 5 2 5 3 8 Unknown 14 33 8 19 3 14 3 8 6 17 TOTAL 43 100 43 100 22 100 37 100 36 100 Year 2008 2009 2010 2011 2012 n n n n n Rejection acutechronic 27 63 24 62 28 58 19 43 20 48 Calcineurin toxicity 1 3 1 2 1 2 4 10 Other drug toxicity 1 3 1 2 Ureteric obstruction 1 2 Infection 3 7 1 3 Vascular causes 3 7 1 3 3 6 1 2 1 2 Recurrent de novo renal disease 1 2 1 2 Others 3 7 1 3 4 8 4 9 1 2 Unknown 6 14 10 26 11 23 19 43 14 33 TOTAL 43 100 39 100 48 100 44 100 42 100

5.5 PATIENT AND GRAFT SURVIVAL