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
5.5.1 Patient and Graft Survival Overall patient survival rates from 1993 to 2012 were 95, 92, 88 and 79 at year 1, 3,
5 and 10 respectively. Overall graft survival rates were 92, 86, 80 and 65 at year 1, 3, 5 and 10 respectively Figure Table 5.5.1.1 and 5.5.1.3.
Factors affecting patient survival are year of transplantation, age at transplantation, primary disease and type of transplantation. Patients who underwent renal transplantation in later
years have higher risk of mortality. This may be due to the acceptance of patients with more co-morbidities to undergo renal transplantation during later years. Older patients are also at
higher risk of mortality. Diabetes as primary renal disease has a tendency for higher mortality but this was not statistically significant. However, patients with glomerulonephritis and
systemic lupus nephritis have better survival in comparison to those with an unknown primary Table 5.5.1.2.
Factors affecting allograft survival are year of transplantation and type of transplantation. Patients who underwent renal transplantation in later years are more likely to lose their
allografts. This may be due to the acceptance of marginal organs and transplanting patients with marked vascular calcifications, which pose difficulties with surgical anastomoses. This
is supported by the fact that local cadaveric transplants are at higher risk of losing their allografts in comparison to other types of transplantation Table 5.5.1.4.
19
Table 5.5.1.1: Patient survival, 1993-2012
Interval years n
Survival SE
2879 100
1 2553
95 2
2357 93
3 2162
92 1
4 1959
90 1
5 1783
88 1
6 1603
86 1
7 1409
84 1
8 1208
83 1
9 1020
81 1
10 872
79 1
n=Number at risk SE=standard error
0.00 0.25
0.50 0.75
1.00
C u
m u
la ti
v e
s u
rv iv
a l
2 4
6 8
10 12
14 16
18 20
Duration in years Transplant patient survival, 1993-2012
Figure 5.5.1.1: Patient survival, 1993-2012 Table 5.5.1.2: Risk factors for transplant patient survival 1993-2012
Factors n
Hazard Ratio 95 CI
P value Year of transplant
1993-2002
ref
1441 1.00
2003-2012 1402
3.59 2.79;4.59
0.001
Age at transplant
20 258
0.66 0.4;1.1
0.109 20-39
ref
1200 1.00
40-54 1238
1.73 1.38;2.16
0.001 =55
147 2.35
1.63;3.39 0.001
Gender:
Male
ref
1791 1.00
Female 1052
0.84 0.68;1.03
0.097
Primary diagnosis
Unknown primary
ref
853 1.00
Diabetes mellitus 227
1.31 0.99;1.73
0.058 GNSLE
851 0.72
0.55;0.93 0.013
Polycystic kidney 54
1.18 0.59;2.33
0.643 Obstructive nephropathy
97 1.27
0.8;2.02 0.313
20
Others 628
1.00 0.76;1.3
0.988
Type of transplant
Commercial cadaver
ref
1250 1.00
Commercial live donor 415
0.89 0.68;1.18
0.429 Living donor
746 0.90
0.66;1.21 0.478
Cadaver 378
3.26 2.41;4.41
0.001
HBsAg
Negative
ref
2741 1.00
Positive 102
1.11 0.76;1.62
0.591
Anti-HCV
Negative
ref
2681 1.00
Positive 162
1.02 0.74;1.41
0.907
Table 5.5.1.3: Graft survival, 1993-2012
Interval years n
Survival SE
2879 100
1 2553
92 1
2 2357
89 1
3 2162
86 1
4 1959
83 1
5 1783
80 1
6 1603
77 1
7 1409
73 1
8 1208
71 1
9 1020
68 1
10 872
65 1
n=Number at risk SE=standard error
0.00 0.25
0.50 0.75
1.00
C u
m u
la ti
v e
s u
rv iv
a l
2 4
6 8
10 12
14 16
18 20
Duration in years Transplant graft survival, 1993-2012
Figure 5.5.1.3: Graft survival, 1993-2012
21
Table 5.5.1.4: Risk factors for transplant graft survival 1993-2012
Factors n
Hazard Ratio 95CI
P value Year of transplant
1993-2002
ref
1441 1.00
2003-2012 1402
3.55 2.94;4.28
0.001
Age at transplant
20 258
0.97 0.75;1.27
0.851 20-39
ref
1200 1.00
40-54 1238
0.97 0.83;1.13
0.673 =55
147 1.13
0.83;1.53 0.448
Gender:
Male
ref
1791 1.00
Female 1052
1.01 0.87;1.16
0.944
Primary diagnosis
Unknown primary
ref
853 1.00
Diabetes mellitus 227
1.23 0.97;1.55
0.090 GNSLE
851 1.02
0.85;1.22 0.837
Polycystic kidney 54
1.24 0.7;2.18
0.457 Obstructive nephropathy
97 0.82
0.55;1.24 0.350
Others 628
1.36 1.12;1.65
0.002
Type of transplant
Commercial cadaver
ref
1250 1.00
Commercial live donor 415
0.95 0.77;1.17
0.620 Living donor
746 1.04
0.86;1.27 0.669
Cadaver 378
2.83 2.27;3.54
0.001
HBsAg
Negative
ref
2741 1.00
Positive 102
1.17 0.89;1.55
0.267
Anti-HCV
Negative
ref
2681 1.00
Positive 162
1.08 0.85;1.36
0.542
5.5.2 Survival according to type of transplant Outcomes of renal transplantation over the last 20 years in the 4 different donor groups are
shown in Figures 5.5.2.1 and Figure 5.5.2.2. For local living renal transplantation, the patient survival was 97, 96, 94 and 88,
while the graft survival was 92, 90, 86 and 71 at year 1, 3, 5 and 10 respectively. For commercial cadaveric allografts, patient and graft survival was 96, 92, 87 and 79 and
94, 89 and 82 and 70 at year 1, 3, 5 and 10 years respectively The patient survival of local cadaveric allograft recipients is worse in comparison to all other
groups. This may be due to older age and more co-morbidities in this group. Both patient and allograft survival of local cadaveric renal transplantation were poorer than commercial
cadaveric transplant.
22
Table 5.5.2.1: Unadjusted patient survival by type of transplant, 1993-2012
Type of Transplant
Commercial Cadaver
Commercial Live Donor
Live Donor Cadaver
Interval years n
Survival SE
n Survival
SE n
Survival SE
n Survival
SE
1252 100
423 100
745 100
379 100
1 1165
96 1
383 97
1 637
97 1
285 89
2 2
1127 94
1 345
95 1
588 96
1 232
86 2
3 1079
92 1
297 92
1 541
96 1
194 84
2 4
1005 89
1 263
90 2
485 94
1 163
83 2
5 914
87 1
243 87
2 447
94 1
142 80
2 6
844 85
1 220
84 2
394 93
1 113
78 3
7 740
83 1
193 80
2 355
91 1
95 77
3 8
628 83
1 180
77 2
304 90
1 83
75 3
9 500
81 1
161 74
3 272
88 1
74 73
3 10
416 79
1 152
72 3
239 88
2 59
71 3
n=Number at risk SE=standard error
Figure 5.5.2.1: Patient survival by type of transplant, 1993-2012
Commercial cadaver Commercial live donor
Live donor Cadaver
0.00 0.25
0.50 0.75
1.00
C u
m u
la ti
v e
s u
rv iv
a ll
2 4
6 8
10 12
14 16
18 20
22 Duration in years
Transplant patient survival by Type of Transplant, 1993-2012
23
Table 5.5.2.2: Graft survival by type of transplant, 1993-2012
Type of Transplant
Commercial Cadaver
Commercial Live Donor
Live Donor Cadaver
Interval years n
Survival SE
n Survival
SE n
Survival SE
n Survival
SE
1252 100
423 100
745 100
379 100
1 1167
94 1
392 95
1 638
92 1
286 81
2 2
1129 91
1 353
91 1
584 91
1 232
76 2
3 1081
89 1
306 86
2 542
90 1
195 73
2 4
1007 85
1 271
82 2
488 87
1 163
70 3
5 916
82 1
251 77
2 446
86 1
142 67
3 6
847 80
1 227
72 2
394 83
2 113
63 3
7 742
77 1
198 66
3 353
81 2
96 61
3 8
629 74
1 182
63 3
301 78
2 83
58 3
9 504
72 1
162 59
3 267
75 2
74 56
3 10
418 70
1 153
55 3
234 71
2 59
51 4
n=Number at risk SE=standard error
Commercial cadaver Cadaver
Live donor
Commercial live donor
0.00 0.25
0.50 0.75
1.00
C u
m u
la ti
v e
s u
rv iv
a l
2 4
6 8
10 12
14 16
18 20
22 Duration in years
Transplant graft survival by Type of Transplant, 1993-2012
Figure 5.5.2.2: Graft survival by type of transplants, 1993-2012 5.5.3 Outcome of Living Related Renal Transplantation
Patient and graft survival for living related transplants were compared between two cohorts, those transplanted between 1993-2002 and 2003-2012. In living related transplants, the
patient survival between these 2 cohorts was similar. However, the allograft survival was better in patients who underwent transplantation between 2003 and 2012, which may be
contributed by better surgical techniques and more potent immunosuppression used in this group of patients Figure 5.5.3.1 Figure 5.5.3.2.
24
Table 5.5.3.1: Patient survival by year of transplant Living related transplant, 1993-2012
Year of Transplant 1993-2002
2003-2012 Interval years
n Survival
SE n
Survival SE
328 100
278 100
1 298
98 1
226 96
1 2
296 97
1 197
96 1
3 285
96 1
175 95
1 4
276 96
1 141
93 2
5 271
95 1
115 93
2 6
259 95
1 93
89 2
7 248
94 1
67 88
3 8
238 93
2 37
88 3
9 228
92 2
19 83
5 10
217 91
2 1
83 5
n=Number at risk SE=standard error
Year 1993-2002 Year 2003-2012
0.00 0.25
0.50 0.75
1.00
C u
m u
la ti
v e
s u
rv iv
a l
2 4
6 8
10 12
14 16
18 20
Duration in years Transplant patient survival by Year of Transplant, 1993-2012
Figure 5.5.3.1: Patient survival by year of transplant Living related transplant, 1993-2012
25
Table 5.5.3.2: Graft survival by year of transplant Living related transplant, 1993-2012
Year of Transplant 1993-2002
2003-2012 Interval years
n Survival
SE n
Survival SE
328 100
278 100
1 322
90 2
317 94
1 2
320 90
2 264
92 1
3 309
87 2
233 92
1 4
299 84
2 189
89 2
5 293
83 2
153 88
2 6
281 79
2 113
85 2
7 270
77 2
83 84
2 8
257 73
2 45
84 2
9 244
70 2
23 84
2 10
233 67
3 1
77 7
n=Number at risk SE=standard error
Year 1993-2002 Year 2003-2012
0.00 0.25
0.50 0.75
1.00
C u
m u
la ti
v e
s u
rv iv
a l
2 4
6 8
10 12
14 16
18 20
Duration in years Transplant graft survival by Year of Transplant, 2002-2012
Figure 5.5.3.2: Graft survival by year of transplant Living related transplant, 1993-2012 5.5.4 Outcome of Commercial Cadaveric Transplantation
Patient and graft survival for commercial cadaveric transplants were compared between two cohorts, those transplanted between 1993-2002 and 2003-2012. Both patient and allograft
survival for commercial cadaveric transplant appears to be better in cohorts that were transplanted between the years 2003-2012 Figure 5.5.4.1 Figure 5.5.4.2.
26
Table 5.5.4.1: Patient survival by year of transplant Commercial cadaver transplant, 1993- 2012
Year of Transplant 1993-2002
2003-2012 Interval years
n Survival
SE n
Survival SE
642 100
610 100
1 601
95 1
566 96
1 2
585 93
1 544
94 1
3 569
91 1
517 92
1 4
536 88
1 471
91 1
5 510
86 1
406 89
1 6
491 84
1 356
88 1
7 466
81 2
276 87
2 8
448 81
2 181
86 2
9 432
79 2
75 85
2 10
416 78
2 2
85 2
n=Number at risk SE=standard error
Year 1993-2002 Year 2003-2012
0.00 0.25
0.50 0.75
1.00
C u
m u
la ti
v e
s u
rv iv
a l
2 4
6 8
10 12
14 16
18 20
Duration in years Transplant patient survival by Year of Transplant, 1993-2012
Figure 5.5.4.1: Patient survival by year of transplant Commercial cadaver transplant, 1993- 2012
27
Table 5.5.4.2: Graft survival by year of transplant Commercial cadaver transplant, 1993- 2012
Year of Transplant 1993-2002
2003-2012 Interval years
n Survival
SE n
Survival SE
642 100
610 100
1 601
94 1
566 94
1 2
585 91
1 544
92 1
3 569
88 1
517 89
1 4
536 84
1 471
87 1
5 510
80 2
406 85
1 6
491 77
2 356
82 2
7 466
74 2
276 80
2 8
448 72
2 181
78 2
9 432
70 2
75 77
2 10
416 67
2 2
77 2
n=Number at risk SE=standard error
Year 1993-2002 Year 2003-2012
0.00 0.25
0.50 0.75
1.00
C u
m u
la ti
v e
s u
rv iv
a l
2 4
6 8
10 12
14 16
18 20
Duration in years Transplant graft survival by Year of Transplant, 1993-2012
Figure 5.5.4.2: Graft survival by year of transplant Commercial cadaver transplant, 1993- 2012
28
5.6 USE OF IMMUNOSUPPRESSION AND NON IMMUNOSUPPRESSIVE
