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