5
5.1 STOCK AND FLOW
The number of new transplant patients fluctuated in the 1990s and subsequently showed an initial rise from 140 transplants in 1993 to a peak of 192 transplants in 2004. The 94
transplant surgeries performed in 2012 are a substantial decrease from 2011, which was an extension of the continuous decline since 2009 Table Figure 5.1.1. This is predominantly
due to reduction in the number of transplantations performed overseas, which coincides with the drop in the number of patients who underwent renal transplantation in China. This drop is
due to the implementation of restrictions on commercial organ transplantation by the Chinese Ministry of Health.
The number of functioning renal transplants had increased from 734 in 1993 to 1443 in 2002 and to 1894 in 2012 Table 5.1.1.
Despite advances in immunosuppression, the rate of allograft failure remained static with 2- 3 allografts lost every year.
Table 5.1.1: Stock and flow of renal transplantation, 1993-2012
Year 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
New transplant patients 140
204 105
151 129
106 128
144 162
172 Died
24 30
17 37
32 28
29 32
40 38
Graft failure 20
22 27
24 35
48 36
30 39
33 Lost to Follow up
2 2
1 1
5 2
2 Functioning graft at 31
st
December 734
884 943 1033 1095 1124 1186 1263 1344 1443
Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
New transplant patients 162
192 171
151 111
130 141
128 122
94 Died
41 44
48 58
47 59
49 47
54 46
Graft failure 41
43 21
36 36
39 37
46 42
41 Lost to Follow up
4 6
6 3
12 13
12 6
9 9
Functioning graft at 31
st
December 1519 1618 1714 1768 1784 1803 1846 1875 1892 1894
Figure 5.1.1: Stock and flow of renal transplantation, 1993-2012
200 400
600 800
1,000 1,200
1,400 1,600
1,800 2,000
N o
. o
f p
a ti
e n
ts
93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 Year
New patients Functioning graft at 31st Dec
6 The incidence rate of renal transplantation continued to decline, from 6 to 7 million
population in the early 2000s to 4 to 5 million population between 2007 and 2011; this decreased further in 2012 to 3 per million population Table Figure 5.1.2. This rate is
extremely low in comparison to Australia and New Zealand, which reported rates of 38 and 25 per million population respectively in 2010.
Table 5.1.2: New transplant rate per million populations pmp, 1993-2012
Year 1993
1994 1995
1996 1997
1998 1999
2000 2001
2002
New transplant patients 140
204 105
151 129
106 128
144 162
172 New transplant rate pmp
7 10
5 7
6 5
6 6
7 7
Year 2003
2004 2005
2006 2007
2008 2009
2010 2011
2012
New transplant patients 162
192 171
151 111
130 141
128 122
94 New transplant rate pmp
6 7
6 6
4 5
5 5
4 3
1 2
3 4
5 6
7 8
9 10
N e
w T
ra n
s p
la n
t ra
te ,
p m
p
93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12
Year
Rate, pmp
Figure 5.1.2: New transplant rate, 1993-2012 The transplant prevalence rate has grown from 37 per million in 1993 to 65 per million
population pmp in 2005 Table Figure 5.1.3.The transplant prevalence rate has not kept up with the growth in the prevalence rate of dialysis patients which has increased from 71
pmp in 1993 to 975 pmp in 2012. In fact, the transplant incidence rate has reduced over the last ten years and the prevalence rate has remained static over the last 7 years 3 and 65 per
million population respectively Table 5.1.2 and 5.1.3. Table 5.1.3: Transplant prevalence rate per million population, 1993-2012
Year 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Functioning graft at 31
st
December 734
884 943
1033 1095 1124 1186 1263 1344 1443 Transplant prevalence rate pmp
37 44
46 49
50 50
52 54
56 58
Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Functioning graft at 31
st
December 1519 1618 1714 1768 1784 1803 1846 1875 1892 1894
Transplant prevalence rate pmp 60
62 65
66 66
65 66
66 66
65
7
10 20
30 40
50 60
70
T ra
n s
p la
n t
Pr e
v a
le n
c e
r a
te ,
p m
p
93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12
Year
Rate, pmp
Figure 5.1.3: Transplant prevalence rate, 1993-2012 5.2
RECIPIENTS’ CHARACTERISTICS
Over the last 20 years, the age of transplant recipients has remained unchanged, with a mean between 35 to 42 years old. This is unlike changes in the demography of HD patients over the
last two decades. The proportion of new HD patients 55 years old has increased to 72.8 in year 2012. Between 56 and 70 of recipients were males over the last two decades.
Over the two decades, the proportion of diabetic patients undergoing renal transplantation initially increased from 10 to a peak of 23 in 2003 and subsequently decreased slowly
over the last 10 years. This coincided with the drop in China transplants where the majority of the diabetic patients underwent their transplantation. The proportion of diabetic renal
transplant recipients has reduced to 14-16 in the last 2 years Patients with hepatitis B have decreased from 5-8 earlier to 3-4 in the last 2 years.
Similar patterns are seen with patients with Hepatitis C infections. In terms of cause of end stage renal failure Table 5.2.2, glomerulonephritis GN remains
the primary cause, followed by hypertension and diabetes. Up to 40 of transplant recipients had end stage renal disease due to unknown causes, belying the fact that majority of these
patients presented late. Table 5.2.1: Renal transplant recipients’ characteristics, 1993-2012
Year 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
New Transplant Patients 140
204 105
151 129
106 128
144 162
172 Age at transplant years, Mean
38 38
35 38
36 37
37 39
41 40
Age at transplant years, SD 13
11 11
11 12
11 13
14 13
12 Male
60 67
59 56
64 58
63 65
62 58
Diabetic co-morbid primary renal disease 11
12 13
10 11
10 11
16 19
15 HBsAg positive
9 10
7 13
5 6
4 5
5 7
Anti-HCV positive 23
13 16
19 7
18 11
8 15
8
8
Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
New Transplant Patients 162
192 171
151 111
130 141
128 122
94 Age at transplant years, Mean
42 42
38 37
37 37
38 40
38 37
Age at transplant years, SD 13
13 14
15 16
14 14
14 15
13 Male
66 63
68 66
64 59
64 66
70 60
Diabetic co-morbid primary renal disease 23
21 21
18 15
18 20
20 14
16 HBsAg positive
8 5
5 6
9 3
2 4
4 3
Anti-HCV positive 10
8 3
8 9
3 7
3 4
2
Table 5.2.2: Primary causes of end stage renal failure, 1993-2012
Year
1993 1994
1995 1996
1997 n
n n
n n
New transplant patients 140
204 105
151 129
Glomerulonephritis 47
34 67
33 36
34 52
34 39
30 Diabetes Mellitus
9 6
16 8
12 11
10 7
10 8
Hypertension 7
5 9
4 5
5 8
5 8
6 Obstructive uropathy
9 6
5 2
3 3
5 3
4 3
ADPKD 1
1 5
2 1
1 4
3 2
2 Drugs toxic nephropathy
2 1
1 3
2 Hereditary nephritis
Unknown 64
46 98
48 48
46 74
49 65
50 Others
7 5
16 8
7 7
9 6
7 5
Year
1998 1999
2000 2001
2002 n
n n
n n
New transplant patients 106
128 144
162 172
Glomerulonephritis 29
27 42
33 53
37 53
33 57
33 Diabetes Mellitus
6 6
10 8
17 12
23 14
17 10
Hypertension 7
7 8
6 23
16 17
10 27
16 Obstructive uropathy
6 6
4 3
7 5
6 4
3 2
ADPKD 1
1 1
1 4
3 2
1 3
2 Drugs toxic nephropathy
2 2
1 1
1 1
1 1
Hereditary nephritis Unknown
57 54
63 49
52 36
62 38
70 41
Others 5
5 4
3 7
5 10
6 7
4 Year
2003 2004
2005 2006
2007 n
n n
n n
New transplant patients 162
192 171
151 111
Glomerulonephritis 58
36 65
34 60
35 62
41 38
34 Diabetes Mellitus
29 18
32 17
33 19
22 15
12 11
Hypertension 28
17 51
27 54
32 38
25 35
32 Obstructive uropathy
3 2
5 3
3 2
6 4
6 5
ADPKD 5
3 5
3 3
2 1
1 3
3 Drugs toxic nephropathy
2 1
2 1
3 2
1 1
Hereditary nephritis 1
1 Unknown
59 36
90 47
67 39
69 46
46 41
Others 5
3 9
5 4
2 4
3 2
2
9
Year 2008
2009 2010
2011 2012
n n
n n
n
New transplant patients 130
141 128
122 94
Glomerulonephritis 41
32 53
38 50
39 33
27 33
35 Diabetes Mellitus
19 15
26 18
20 16
18 15
13 14
Hypertension 28
22 38
27 42
33 45
37 24
26 Obstructive uropathy
6 5
5 4
7 5
8 7
12 13
ADPKD 8
6 5
4 3
2 1
1 Drugs toxic nephropathy
1 1
Hereditary nephritis 1
1 Unknown
64 49
47 33
40 31
50 41
29 31
Others 6
5 1
1 5
4 6
5 2
2
5.3 TRANSPLANT PRACTICES
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