Post-transplant complications Deaths and Graft loss

Eighth Report of the National Transplant Registry 2011 RENAL TRANSPLANTATION 11 SECTION 5.4: TRANSPLANT OUTCOMES

5.4.1 Post-transplant complications

In the year 2011, 57 of patients were hypertensive prior to transplantation whereas 29 developed hypertension post transplantation. Thirteen percent of patients had diabetes mellitus prior to transplant whereas only 7 of patients developed new onset diabetes after transplantation NODAT. These trends have been quite the same since 2007. In terms of cardiovascular and cerebrovascular disease 3 had either or both prior to transplant and another 3 developed these post transplantation. Table 5.4.1: Post-transplant complications, 2007-2011 Medication data Pre Transplant 2007 2008 2009 2010 2011 n n n n n All patients 1688 100 1705 100 1710 100 1862 100 1912 100 Diabetes either as primary renal disease or co- morbid 232 14 233 14 211 12 246 13 257 13 Cancer 3 2 1 3 2 Cardiovascular disease + cerebrovascular disorder 72 4 67 4 51 3 63 3 60 3 Hypertension 1064 63 1055 62 1028 60 1095 59 1093 57 Post transplant All patients 1688 100 1705 100 1710 100 1862 100 1912 100 Diabetes either as primary renal disease or co- morbid 113 7 119 7 88 5 120 6 127 7 Cancer 21 1 24 1 16 1 19 1 18 1 Cardiovascular disease + cerebrovascular disorder 54 3 72 4 56 3 48 3 54 3 Hypertension 451 27 413 24 448 26 502 27 562 29 Hypertension: BP systolic140 and BP diastolic 90 OR have either Beta blocker Calcium channel blocker ACE inhibitor AIIRB Other anti-hypertensive

5.4.2 Deaths and Graft loss

In 2011, 38 transplant recipients died and 41 lost their grafts. The rates of transplant death and graft loss have remained static for the past 10 years Table 5.4.2. The main known causes of death have been infection and cardiovascular disease with 41 and 18 respectively. Another 11 of patients died at home, which is usually presumed to be cardiovascular death as well. Cancer death rates have been significantly high from 2002 to 2011 contributing between 7 to 18 of all deaths. Death due to liver disease has slowly declined from 13 in 2002 to around 2 - 4 in the last 3 years. Rejection remains the major cause of graft loss. RENAL TRANSPLANTATION Eighth Report of the National Transplant Registry 2011 12 Table 5.4.2: Transplant patients death rate and graft loss, 2002-2011 Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Number at risk 1389 1476 1563 1660 1735 1769 1784 1812 1846 1872 Transplant death 38 41 44 48 58 47 60 49 45 38 Transplant death rate 2.7 2.8 2.8 2.9 3.3 2.7 3.4 2.7 2.4 2 Graft loss 33 41 43 21 36 36 39 37 46 41 Graft loss rate 2.4 2.8 2.8 1.3 2.1 2 2.2 2 2.5 2.2 Acute rejection 4 19 14 19 14 24 32 80 49 Acute rejection rate 0.3 1.2 0.8 1.1 0.8 1.3 1.8 4.3 2.6 All losses 71 82 87 69 94 83 99 86 91 79 All losses rate 5.1 5.6 5.6 4.2 5.4 4.7 5.5 4.7 4.9 4.2 Graft loss=graft failure All losses=death graft loss acute rejection happens concurrently with graft failure death Figure 5.4.2a: Transplant recipient death rate, 2002-2011 .5 1 1.5 2 2.5 3 3.5 De at h ra te 02 03 04 05 06 07 08 09 10 11 Year Annual death rate Figure 5.4.2b: Transplant recipient graft loss rate, 2002-2011 .5 1 1.5 2 2.5 3 3.5 G ra ft lo ss ra te 02 03 04 05 06 07 08 09 10 11 Year Annual graft loss rate Table 5.4.3: Causes of death in transplant recipients, 2002-2011 Year 2002 2003 2004 2005 2006 n n n n n Cardiovascular 6 15 14 30 6 13 5 10 13 21 Died at home 5 13 5 11 5 11 6 12 7 11 Infection 14 35 13 28 17 36 29 58 25 40 Graft failure 3 6 Cancer 5 13 7 15 8 17 5 10 5 8 Liver disease 5 13 3 7 4 9 3 6 5 8 Accidental death 1 3 1 2 1 2 1 2 Others 2 5 1 2 3 6 2 3 Unknown 2 5 2 4 1 2 1 2 5 8 TOTAL 40 100 46 100 47 100 50 100 63 100 Year 2007 2008 2009 2010 2011 n n n n n Cardiovascular 10 19 11 17 12 22 12 24 8 18 Died at home 5 10 12 18 9 17 7 14 5 11 Infection 19 37 20 30 19 35 16 31 18 41 Graft failure 4 8 1 2 2 4 1 2 Cancer 6 12 12 18 7 13 6 12 3 7 Liver disease 2 4 2 4 1 2 Accidental death Others 1 2 6 9 1 2 5 10 6 14 Unknown 7 13 5 8 3 6 1 2 2 5 TOTAL 52 100 66 100 54 100 51 100 44 100 Eighth Report of the National Transplant Registry 2011 RENAL TRANSPLANTATION 13 Table 5.4.4: Causes of graft failure, 2002-2011 Year 2002 2003 2004 2005 2006 n n n n n Rejection 19 56 20 47 29 67 15 68 25 68 Calcineurin toxicity 1 3 1 2 Other drug toxicity Ureteric obstruction Infection 2 5 1 2 1 5 2 5 Vascular causes 3 7 4 9 2 9 4 11 Recurrent de novo renal disease 2 6 2 5 1 2 1 3 Others 2 6 1 2 1 5 2 5 Unknown 10 29 14 33 8 19 3 14 3 8 TOTAL 34 100 43 100 43 100 22 100 37 100 Year 2007 2008 2009 2010 2011 n n n n n Rejection 24 67 27 63 24 62 29 60 19 46 Calcineurin toxicity 1 3 1 2 1 2 Other drug toxicity 1 3 1 2 Ureteric obstruction 1 3 Infection 1 3 3 7 1 3 Vascular causes 1 3 3 7 1 3 3 6 1 2 Recurrent de novo renal disease 1 2 Others 3 8 3 7 1 3 4 8 3 7 Unknown 6 17 6 14 10 26 10 21 17 41 TOTAL 36 100 43 100 39 100 48 100 41 100

5.5: PATIENT AND GRAFT SURVIVAL