Renal Transplantation in Singapore

Abstract

Introduction: Renal transplantation is the best treatment for kidney failure. As the demand far exceeds the supply, various legislative measures have been put into place in Singapore to increase kidney transplant rates. This paper evaluates the impact of these measures and reports on the outcomes for kidney transplant recipients in Singapore. Materials and Methods: Patient demographics, recipient and donor characteristics, and co-morbidities occurring in incident transplant patients were extracted from Singapore Renal Registry (SRR) Reports from 1997 to 2006, tabulated and summarised. Graft and patient survivals data, which were calculated by Kaplan-Meier analysis until return to dialysis/pre-emptive renal re-transplant or patient death respectively, were extracted from SRR Reports. Published data from the United States Renal Data System (USRDS) and Organ Procurement and Transplantation Network (OPTN) were used for comparisons with data from the SRR. Results: The introduction of the Human Organ Transplant Act increased the rate of deceased donor (DD) kidney transplants from 4.7 per year from 1970 to 1988, to 41.4 per year from 1988 to 2004. In 2006, the overall DD and living donor (LD) rate for kidney transplants performed locally for Singaporeans and permanent residents of Singapore was 22.6 per million population (pmp); taking into account overseas kidney transplants, the kidney transplant rate was 33.0 pmp. One and 5-year graft survivals for local LD and DD transplanted between 1999 and 2006, as reported by the SRR, were 98.1% and 95.3% versus 88.9% and 81.3%, respectively (P <0.001). Patient survivals at 1 and 5 years were likewise significantly better for LD versus DD (99.4% and 96.6% vs. 96% and 89.1%, respectively; P = 0.005). Conclusions: The local kidney transplant rates were lower than those reported by the USRDS for the USA, Spain, Norway and Australia but higher than other Asian countries. While 1-year outcomes for transplants reported to the SRR were similar to that reported by the OPTN, 5-year survivals were significantly higher, possibly due to the selection of patients with fewer co- morbidities for kidney transplantation in Singapore. These results suggest that while outcomes are excellent, there is much more to be done to increase kidney transplantation rates in Singapore so as to meet the needs of end-stage renal failure patients in the country. Key words: Presumed consent, Singapore Renal Registry, Living donor, Kidney transplant, Deceased donor kidney transplant, Graft survival