88
The incidence of renal transplantation stabilised at a modest rate of 5-7 per million population Table 5.1.2 while transplant prevalence rate has grown slowly from 50 per
million in 1997 to 65 per million population in 2006, an increase of 30 over the 1997 figures. However compared to growth in the number of dialysis patients which has
increased by 296 from 3698 in 1997 to 14647 in 2006
, our transplant prevalence rate
has not kept up 14
th
Report of The Malaysian Dialysis and Transplant Registry 2006. Table 5.1.2: New Transplant Rate per million population pmp, 1997-2006
Year 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
New transplant
patients 127 104 127 143 161 168 160 190 162 132 New
transplant rate,
pmp 6 5 6 6 7 7 6 7 6 5
Figure 5.1.2: New Transplant Rate, 1975-2006
N ew
T ra
ns pl
ant Ra
te , pm
p
Year
1 2
3 4
5 6
7 8
9 10
1975 1977 1979
1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001
2003 2005
89
Table 5.1.3: Transplant Prevalence Rate per million population pmp, 1997-2006
Year 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Functioning graft at 31
st
December 1083 1111 1176 1248 1330 1425 1503 1592 1684 1728
Transplant prevalence rate, pmp
50 50 52 53 55 58 60 62 64 65
Figure 5.1.3: Transplant Prevalence Rate, 1975-2006
T ra
ns pl
an t P
re va
le nc
e R at
e, pm p
Year
5 10
15 20
25 30
35 40
45 50
55 60
65 70
1975 1977 1979
1981 1983
1985 1987 1989 1991 1993 1995 1997 1999 2001 2003
2005
90
In terms of location, transplantation within local centres has grown slightly from 35 cases 28 of renal transplants in 1997 to 49 cases 38 of renal transplants in 2006.
This translates to a net increase of 1.4 cases per year over the 10 year period. This is disturbing as it underscores our failure to improve transplantation rates within the
country. Transplantation in China in 2006 comprised the majority of renal transplant recipients with 75 patients 57 of transplants.
Table 5.1.4: Place of Transplantation, 1997-2006
Year 1997 1998 1999 2000 2001
No. No. No. No. No.
HKL 29 23 33 32 36 28 28 20 33 20
UMMC 6 5 7 7 16 13 19 13 23 14
Selayang Hospital 0 0 0 0 0 0 4 3 11 7
Other local
0 0 0 0 1 1 3 2 4 2 China
80 63 50 48 62 49 80 56 82 51 India
7 6 7 7 5 4 9 6 7 4 Other
overseas 3 2 3 3 2 2 0 0 1 1
Unknown 2 2 4 4 5 4 0 0 0 0
TOTAL 127 100 104 100 127 100 143 100 161 100
Year 2002 2003
2004 2005
2006 TOTAL
No. No. No. No. No. No.
HKL 28 17 26 16 20 11 32 20 35 27 332 20
UMMC 14 8 6 4 7 4 7 4 5 4 117 7
Selayang Hospital 11 7 11 7 11 6 5 3 7 5 60 4
Other local
1 1 1 1 2 1 5 3 2 2 19 1 China
102 61 111 69 137 72 108 67 75 57 992 61 India
12 7 4 3 11 6 5 3 7 5 80 5 Other
overseas 0 0 1 1 2 1 0 0 0 0 13 1
Unknown 0 0 0 0 0 0 0 0 1 1 12 1
TOTAL 168 100 160 100 190 100 162 100 132 100 1625 100
91
5.2 RECIPIENTS’ CHARACTERISTICS
In terms of renal transplant recipients’ characteristics, age at transplant have been stable at 36 to 42 years and between 64 and 68 of recipients are male. There has been an
increase in diabetic patients undergoing transplantation from 11 in 1997 to 20 in 2006 Table 5.2.1. For patients with hepatitis B and hepatitis C, the figures are static at
around 7 although there was an initial increase up to 18 for the hepatitis C population. In terms of cause of end stage renal failure Table 5.2.2, the primary cause
was still glomerulonephritis, followed by hypertension and diabetes as the second and third causes. Up to 31 of transplant recipients had end stage renal disease due to
unknown causes, belying the fact that we often diagnose these patients too late. Table 5.2.1: Renal Transplant Recipients’ Characteristics, 1997-2006
Year 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
New Transplant
Patients 127 104 127 143 161 168 160 190 162 132
Age at transplant years, Mean
36 37 37 40 41 41 42 41 38 37 Age at transplant years,
SD 12 11 13 14 13 13 13 13 14 15
Male 64 58 62 64 63 57 66 62 69 68
Diabetic co-morbid primary
renal disease
11 10 10 15 19 15 22 21 19 20 HBsAg
positive 5 6 4 5 5 7 8 5 4 7
Anti-HCV positive
7 18 11 8 15 9 10 8 2 7
Table 5.2.2: Primary Causes of End Stage Renal Failure, 1997-2006
Year 1997 1998
1999 2000
No. No. No. No.
New transplant
patients 127 100 104 100 127 100 143 100
Glomerulonephritis 30 24 28 27 41 32 49 34
Diabetes Mellitus
9 7 5 5 10 8 16 11 Hypertension
5 4 5 5 7 6 18 13
Obstructive uropathy
3 2 4 4 4 3 3 2 ADPKD
2 2 1 1 1 1 3 2 Drugstoxic
nephropathy 0 0 0 0 0 0 0 0
Hereditary nephritis
0 0 0 0 0 0 0 0 Unknown
64 50 55 53 62 49 54 38 Others
18 14 10 10 6 5 12 8
Year 2001 2002 2003 2004 2005 2006
No. No. No. No. No.
No.
New transplant
patients 161 100 168 100 160 100 190 100 162 100 132 100
Glomerulonephritis 42 26 53 32 54 34 62 33 46 28 48 36
Diabetes Mellitus
23 14 16 10 26 16 32 17 27 17 21 16 Hypertension
17 11 24 14 25 16 51 27 38 23 28 21 Obstructive
uropathy 3 2 2 1 2 1 4 2 3 2 4 3
ADPKD 1 1 3 2 5 3 5 3 3 2 1 1
Drugstoxic nephropathy 0 0 0 0 2 1 2 1 0 0 0 0
Hereditary nephritis
0 0 0 0 0 0 1 1 0 0 0 0 Unknown
61 38 68 40 58 36 83 44 50 31 41 31 Others
23 14 15 9 12 8 27 14 17 10 15 11
92
5.3 TRANSPLANT PRACTICES
In 2006, 62 of the renal transplant recipients received their grafts from commercial sources. Fifty-nine percent of these were from commercial cadavers. Live donor
transplantation made up 20 of transplants 26 recipients in the same year which was down from 45 cases 37 in 1999 and 40 cases 25 in 2005. Local cadaveric
donation made up 18 of transplants 24 recipients in 2006 although it had shown an initial promising rise to 37 recipients in 2001.
Table 5.3.1: Type of Renal Transplantation, 1997-2006
Year 1997 1998
1999 2000
2001 No. No. No. No. No.
Commercial Cadaver
81 66 51 52 62 51 80 56 82 51 Commercial
Live Donor
7 6 4 4 4 3 9 6 6 4 Live
Donor genetically
related 27 22 27 27 40 33 21 15 32 20
Live Donor
emotionally related 0 0 2 2 5 4 6 4 4 2
Cadaver 8 7 15 15 10 8 27 19 37 23
TOTAL 123 100 99 100 121 100 143 100 161 100
Year 2002 2003 2004 2005 2006
No. No. No. No. No.
Commercial Cadaver
102 61 112 70 142 76 105 65 78 59 Commercial
Live Donor
11 7 3 2 5 3 8 5 4 3 Live
Donor genetically
related 30 18 25 16 21 11 37 23 22 17
Live Donor
emotionally related 3 2 5 3 2 1 3 2 4 3
Cadaver 22 13 15 9 17 9 9 6 24 18
TOTAL 168 100 160 100 187 100 162 100 132 100
Commercial Cadaver China, India, other oversea Commercial live donor living unrelated Cadaver local
Table 5.3.2: Biochemical Data, 2004-2006
Biochemical parameters Summary 2004 2005 2006
Creatinine, umolL No.
1550 1634
1592 Mean
132.1 133.7
135.7 SD
63.8 65.5
81.4 Median
120 120
120 Minimum
38 35
42 Maximum
817 763
1152 Hb, gdL
No. 1550
1634 1592
Mean 12.9
12.8 12.7
SD 1.9
1.9 1.9
Median 12.9
12.9 12.8
Minimum 4.9
5.5 3.3
Maximum 19.7
19 19.8
Albumin, gL No.
1550 1634
1592 Mean
39.4 39.5
39.5 SD
1 0.5
0.7 Median
39.4 39.4
39.4 Minimum
22 34
29 Maximum
50 46
48 Calcium, mmolL
No. 1550
1634 1592
Mean 2.4
2.3 2.3
SD 0.2
0.2 0.2
Median 2.3
2.3 2.3
Minimum 1.1
1.2 1.1
Maximum 3.3
3.3 3.1
