1. CHAPTER 4 LIVER TRANSPLANTATION Editors: Dr Ganesalingam A/L Kanagasabai Expert panel: Dr Ganesalingam A/L Kanagasabai (Chairperson) Professor Dr Lee Way Seah Dr Lim Chooi Bee Dr Lim Kin Foong Dr Haniza Binti Omar

2. Table 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008 Year9394959697*989900010203**0405060708 New transplant patients1181332835105165875 Deaths0034114125156322 Re-Transplant0000000000000000 Lost to follow up0000000101001000 Functioning graft at 31st December 12716181923242731354644495457 Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008 Number of patients (n) Year 0 5 10 15 20 25 30 35 40 45 50 55 60 New patients Alive at 31st Dec 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 *1 patient who was alive until 05/12/1997 is recorded dead with missing date of death ** 1 patient transplanted in 2003 is recorded as dead with missing date of death

3. Table 4.1.2 Distribution of Patients by Place of Transplant, 1993-2008 Place of Transplant Year (No.) 93949596979899000102030405060708TOTAL Local00810118359214587586 Overseas110321000132000014 TOTAL1181332835105165875100 Table 4.1.3 Distribution of Patients by Centres for Liver Transplantation, 1993-2008 Transplant Centre Year (No.) 93949596979899000102030405060708TOTAL Sime Darby Medical Centre, Subang Jaya 0081011835627000051 Hospital Selayang000000000307587535 University of Malaya Medical Centre 00000000000000000 Royal Children's Hospital, Brisbane 00021000000000003 National University Hospital, Singapore 00001100000000002 Queensland Liver Transplant Service, Australia 10010000000000002 Kings College Hospital, UK 01000000000000001 Tianjin, China00000000001100002 Asian Centre for Liver Disease & Transplantation, Singapore 000000000121----4 TOTAL 1181332835105165875100

4. Table 4.2.1 Distribution of Patients by Gender, 1993-2008 Gender Year (No.) 93949596979899000102030405060708TOTAL Male0065213127510263154 Female112811523306324446 TOTAL1181332835105165875100 Figure 4.2.1 Distribution of Patients by Gender, 1993-2008 Number of patients (n) Year 0 2 4 6 8 10 Male Female 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

5. Table 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008 Ethnic group Year (No.) 93949596979899000102030405060708TOTAL Malay0123104123111332239 Chinese106821223645134351 Indian00020110000012108 Others00000010010000002 TOTAL1181332835105165875100 Figure 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008 Number of patients (n) Year 0 2 4 6 8 10 12 Malay Chinese Indian Others 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

6. Table 4.2.3 Distribution of Patients by Age, 1993-2008 Age Group* Year (No.) 93949596979899000102030405060708 TOTA L <100000100000000001 1-41131131534529243158 5-9003100201313312121 10-1400110000000101105 15-1900000010000100002 20-3900100000010002138 40-5900000000011100003 ≥6000000000001100002 TOTAL1181332835105165875100 Mean2494214121027124 10179 SD--9411502143322315131014 Median245221212493545233 Minimum24221 3 months 111 4 months 111222 3 months Maximum243014211525467374839372674

7. Table 4.2.4 Primary Diagnosis, 1993-2008 (N=100) Primary diagnosis Year (No.) 93949596979899000102030405060708TOTAL Biliary atresia11712317256210426372 Metabolic liver disease00110000020200006 Cholestatic liver disease00000101000010003 Primary biliary cirrhosis00000000000000000 Primary sclerosing cholangitis00000000000000000 Autoimmune hepatitis00000010000000001 Chronic hepatitis B00000000003200005 Chronic hepatitis C00000000000000000 Alcoholic liver disease00000000000000000 Malignancies00000000012100004 Acute liver failure00000000000103004 Idiopathic/ Cryptogenic00000000000000000 Others000000000201141312 TOTAL1181332835117176976107 ** 7 patients have more than one primary disease

8. Table 4.2.5 Indication for Transplantation, 1993-2008 (N=100) Indication for transplantation Year (No.) 93949596979899000102030405060708TOTAL Recurrent encephalopathy00100010010000003 Uncontrolled bleeding varices000710411002000016 Intractable ascites00000000000000000 Spontaneous bacterial peritonitis00000000000000000 Poor liver function117113183593 414072 Malignancy00000000001000001 Unacceptable quality of life00000000010010002 Failure to thrive and growth retardation in paediatric patients 006103263572 310058 Others000000000001283519 No data00000000011200004 TOTAL11142873197111972610 75175 ** 33 patients had 1 indication for transplant, 63 had more than 1 indication for transplantation

9. Table 4.2.6 Recipients’ Blood Group, 1993-2008 Blood group Year (No.) 93949596979899000102030405060708TOTAL A012000301314142123 B001201201101133117 AB00010100000110004 O002510333518212238 No Data103520000132000118 TOTAL1181332835105165875100

10. Table 4.3.1 Distribution of Patients by Type of Donors, 1993-2008 Type of donor Year (No.) 93949596979899000102030405060708TOTAL Cadaveric100310000114244425 Living Related - Mother015212522227110033 Living Related - Father002710202301133126 Living Related - Daughter00000000000000000 Living Related - Son00000000001100002 Living Related - Brother00000000010000001 Living Related - Sister00000000000000000 Living Related - Monozygotic twin 00000000000000000 Living Related - Dizygotic twin 00000000000000000 Living Related - Others00000000000010001 Living Related - Emotionally00000000001000001 Living Unrelated001100111303000011 TOTAL patients1181332835105165875100

11. Table 4.3.2 Immunosuppresive Drug Treatment at Transplantation, 1993-2008 (N=100) Immunosuppressive drugs Year (No.) 93949596979899000102030405060708TOTAL Steroids0025025255112586563 Azathioprine000000000004584223 Cyclosporin A11120001000000006 Tacrolimus (FK506)0037228259512585477 Mycophenolate Mofetil (MMF) 00000000000000000 Rapamycin00000000012000003 Monoclonal/Polyclonal Antiodies 00000000000000000 Anti IL26 Antibodies00000000000000000 Others00000000000000000 No Data004310000104001014 TOTAL patients1181332835105165875100 Note: 22 patients had 1 type if drug, 41 patients had 2 types, 23 patients had 3 types.

12. Table 4.4.1 Patient Survival by Year of Transplant, 1993-2008 (N=100) Interval (months) Year of transplant 1993-19981999-2008 % SurvivalSE% SurvivalSE 1827 5 6719705 12719696 Figure 4.4.1 Patient Survival by Year of Transplant, 1993-2008

13. Table 4.4.2 Patient Survival by Gender, 1993-2008 (N=100) Interval (months) Gender MaleFemale % SurvivalSE% SurvivalSE 1835806 6726697 12706697 Figure 4.4.2 Patient Survival by Gender, 1993-2008

14. Table 4.4.3 Patient Survival by Age Group, 1993-2008 (N=100) Interval (months) Age Group 0-9 years≥10 years % SurvivalSE% SurvivalSE 1815858 6705809 127057410 Figure 4.4.3 Patient Survival by Age Group, 1993-2008

15. Table 4.4.4 Distribution of Patients by Cause of Death, 1993-2008 (N=100) Year199519961997199819992000200120022003200420052006 20072008 TOTAL Causes of deathNo. Graft failure000001000020 1 04 Chronic graft rejection000000100000001 Intra-abdominal Bleeding000000001000001 Peritonitis000000010000001 CMV Pneumonia000010000000001 Decompensated liver cirrhosis000000010000001 Intracranial hemorrhage010010000000002 Malignancy000000000010012 Variceal bleed001020000000003 Pneumonia and respiratory failure010000000000001 Post transplant lymphoproliferative disease000000100000001 Sepsis0200000201230010 Acute liver failure secondary to portal vein thrombosis post liver transplant 11 End stage liver failure recurrent ascending cholangitis 11 Acute or Chronic Liver Failure112 Viral bronchopneumonia11 Hepatitis B11 Cholethiasis11 Unknown300000010300007 TOTAL341141251664 2 242