1. Table 5.1.1: Stock and Flow of Renal Transplantation, 1998-2007 Year1998199920002001200220032004200520062007 New transplant patients10412714316216916019016313886 Died26253037323741435034 Graft failure493632403841442136 Lost to Follow up1194541411 12 Functioning graft at 31st December1112117712491330142415021593168117221726 Figure 5.1.1: Stock and Flow of Renal Transplantation, 1975-2007

2. Table 5.1.2: New Transplant Rate per million population (pmp), 1998-2007 Year 1998199920002001200220032004200520062007 New transplant patients10412714316216916019016313886 New transplant rate, pmp5667767653 Figure 5.1.2: New Transplant Rate, 1975-2007

3. Table 5.1.3: Transplant Prevalence Rate per million population (pmp), 1998-2007 Year1998199920002001200220032004200520062007 Functioning graft at 31st Dec1112117712491330142415021593168117221726 Transplant prevalence rate, pmp50525355586062646564 Figure 5.1.3: Transplant Prevalence Rate, 1975-2007

4. Table 5.1.4: Place of Transplantation, 1998-2007 Year19981999200020012002 No.% % % % % HKL33323628 2033202817 UMMC77161319132314 8 Selayang Hospital000043117 7 Other local0011324211 China504862498056835110361 India77549674127 Other overseas3322001100 Unknown4454000000 TOTAL104100127100143100162100169100 Year20032004200520062007TOTAL No.% % % % % % HKL2616201132203525354130621 UMMC64747454001047 Selayang Hospital117 653861416755 Other local1121532133222 China1116913772108667957293484258 India43116537511685 Other overseas1121112145161 Unknown000000000091 TOTAL160100190100163100138100861001442100

5. Table 5.2.1: Renal Transplant Recipients’ Characteristics, 1998-2007 Year1998199920002001200220032004200520062007 New Transplant Patients10412714316216916019016313886 Age at transplant (years), Mean37 3941 4241383735 Age at transplant (years), SD111314131213 1415 % Male58626462576662706762 % Diabetic (co-morbid/ primary renal disease)101115191522 20 12 % HBsAg positive6455785475 % Anti-HCV positive181181591082711

6. Year20032004200520062007 No.% % % % % New transplant patients16010019010016310013810086100 Glomerulonephritis54346233452851372630 Diabetes Mellitus261632172918211567 Hypertension25165127382329212023 Obstructive uropathy2142324311 ADPKD5353321100 Drugs / toxic nephropathy2121001100 Hereditary nephritis0011000000 Unknown58368344503142303237 Others128271417101612 14 Table 5.2.2: Primary Causes of End Stage Renal Failure, 1998-2007 Year19981999200020012002 No.% % % % % New transplant patients104100127100143100162100169100 Glomerulonephritis28274132493443275331 Diabetes Mellitus5510816112314169 Hypertension5576201417102414 Obstructive uropathy4443323221 ADPKD1111321132 Drugs / toxic nephropathy0000000000 Hereditary nephritis0000000000 Unknown54526249543861386840 Others11 651282314169

7. Table 5.3.1: Type of Renal Transplantation, 1998-2007 *Commercial Cadaver (China, India, other oversea) *Commercial live donor (living unrelated) *Cadaver (local) Year19981999200020012002 No.% % % % % Commercial cadaver51 62518056835110361 Commercial live donor44439664117 Live donor (genetically related)28 4033211532203018 Live donor (emotionally related)2254644232 Cadaver15 108271937232213 Total100 121100143100162100169100 Year20032004200520062007 No.% % % % % Commercial cadaver11270143761056480582833 Commercial live donor3263855422 Live donor (genetically related)25162111382324172024 Live donor (emotionally related)532132431113 Cadaver1591799625182428 Total16010018910016310013810085100

8. Table 5.3.2: Biochemical Data, 2005-2007 Biochemical parametersSummary200520062007 Creatinine, umol/LN163515921685 Mean133.6135.7131.9 SD65.481.377.6 Median120 116 Minimum3521.736 Maximum76311521186 Hb, g/dLN163515921685 Mean12.812.712.8 SD1.9 Median12.912.8 Minimum5.53.34.4 Maximum1919.818.7 Albumin, g/LN163515921685 Mean39.9 SD0.50.70.8 Median39.9 Minimum3429 Maximum4648 Calcium, mmol/LN163515921685 Mean2.3 SD0.2 Median2.3 Minimum1.21.11.4 Maximum3.33.13.2

9. Phosphate, mmol/LN163515921685 Mean1.1 SD0.2 0.3 Median1.1 Minimum0.5 Maximum3.33.53.9 Alkaline Phosphate (ALP), U/LN163515921685 Mean7979.1 SD46.543.238.4 Median737172 Minimum202422 Maximum831700439 ALT, U/LN163515921685 Mean30.829.9 SD30.930.425.7 Median242223 Minimum444 Maximum613433356 Biochemical parametersSummary200520062007

10. Total cholesterol, mmol/LN163515921685 Mean5.3 5.2 SD111 Median5.3 Minimum1.71.51.7 Maximum10.111.111.4 LDL cholesterol, mmol/LN163515921685 Mean333 SD0.8 Median333 Minimum0.911 Maximum9.211.18.9 HDL cholesterol, mmol/LN163515921685 Mean1.6 1.5 SD0.5 0.4 Median1.6 Minimum0.4 Maximum5.65.87.5 Systolic Blood Pressure, mmHgN163515921685 Mean133.3130.8131.7 SD16.915.915.7 Median130 Minimum806680 Maximum220210 Biochemical parametersSummary200520062007

11. Biochemical parametersSummary200520062007 Diastolic Blood Pressure, mmHgN163515921685 Mean80.578.978.8 SD9.29.89.4 Median80 Minimum503020 Maximum127120116

12. Table 5.3.3: Medication Data, 2005-2007 Medication dataSingle drug treatmentCombined drug treatment 200520062007200520062007 N%N%N%N%N%N% All156310014801001661100156310014801001661100 (i) Immunosuppressive drug(s) treatment Prednisolone1218191152998144297160797 Azathioprine100000605394963447829 Cyclosporin A405080122178111876118872 Tacrolimus (FK506)000040225142541734721 Mycophenolate Mofetil (MMF) 000010683447084890354 Rapamycin0000008160332 Others00000010118140 (ii) Non-Immunosuppressive drug(s) treatment Beta blocker1057775905667435974073544 Calcium channel blocker 195121991318311822537875390354 ACE inhibitor604393382342222922038423 AIIRB201272181161101411021013 Anti-lipid67415510946602396784673044 Other anti-hypertensive501116015810159111408

13. Table 5.4.1: Post Transplant Complications, 2005-2007 Post transplant complications Complication developed before transplant (regardless of complication after transplantation) Complication developed only after transplantation 200520062007200520062007 No.% % % % % % All patients163710015921001685100163710015921001685100 Diabetes (either as Primary Renal Disease or co-morbid) 219132151422814122712581137 Cancer202030191201211 Cardiovascular disease + cerebrovascular disorder 785735724453 3543 Hypertension104964103265105963438273552245327 *Hypertension: BP systolic>140 and BP diastolic >90 OR have either Beta blocker/ Calcium channel blocker / ACE inhibitor / AIIRB / Other anti-hypertensive

14. Table 5.4.2: Transplant Patients Death Rate and Graft Loss, 1998– 2007 Year1998199920002001200220032004200520062007 No. at risk1097114412121289137614621547163617011723 Transplant death26253037323741435034 Transplant death rate %2223233332 Graft loss493632403841442136 Graft loss rate %4333333122 Acute rejection00000319141810 Acute rejection rate %0000001111 All losses75616277707885648670 All losses rate %7556555454 *Graft loss=graft failure *All losses=death / graft loss (acute rejection happens concurrently with graft failure / death)

15. Figure 5.4.2 (i): Transplant Recipient Death Rate, 1976-2007 Figure 5.4.2 (ii): Transplant Recipient Graft Loss Rate, 1976-2007

16. Table 5.4.3: Causes of Death in Transplant Recipients, 1998-2007 Year19981999200020012002 No.% % % % % Cardiovascular31141310297165 Died at home41561913512516 Infection103772312352047928 Graft failure0000260000 Cancer31131026614413 Liver disease27310131239 Accidental death0013131213 Others27516392539 Unknown31126261226 TOTAL2710031100341004310032100 Year20032004200520062007 No.% % % % % Cardiovascular9234951110187 Died at home512613511713410 Infection11281124225022401333 Graft failure0024000038 Cancer61581851147615 Liver disease2537375900 Accidental death0000000000 Others5121022374725 Unknown25121235410 TOTAL4010045100441005510039100

17. Table 5.4.4: Causes of Graft Failure, 1998-2007 Year19981999200020012002 No.% % % % % Rejection28532364195925612255 Calcineurin toxicity0000000000 Other drug toxicity0000000000 Ureteric obstruction0000000000 Infection1200132500 Vascular causes3613391200 Recurrent / de novo renal disease 1200002525 Others59002600410 Unknown1528123372211271230 TOTAL5310036100321004110040100 Year20032004200520062007 No.% % % % % Rejection21483370187528682569 Calcineurin toxicity0000001200 Other drug toxicity0012000000 Ureteric obstruction0000000013 Infection2512143713 Vascular causes3749283713 Recurrent / de novo renal disease 2512001200 Others12001437411 Unknown15347152825411 TOTAL4410047100241004110036100

18. Table 5.5.1: Patient Survival, 1994-2007 Interval (years)No.% SurvivalSE 11777951 31380911 5993881 10349811 12151762 No.=Number at risk SE=standard error Figure 5.5.1: Patient Survival, 1994-2007

19. Table 5.5.2: Graft Survival, 1994-2007 Interval (years)No.% SurvivalSE 11777921 31380851 5993791 10349641 12151572 No.=Number at riskSE=standard error Figure 5.5.2: Graft Survival, 1994-2007

20. Table 5.5.3: Patient Survival by Type of Transplant, 1994-2007 Type of Transplant Commercial CadaverCommercial Live DonorLive DonorCadaver Interval (years)No. % Survival SENo. % Survival SENo. % Survival SENo. % Survival SE 1997961212961395961146843 3770921174902312951104793 550088114487225494180753 101618228670491 27704 123477370654458732-- No.=Number at riskSE=standard error Figure 5.5.3: Patient Survival by Type of Transplant, 1994-2007

21. Table 5.5.4: Graft Survival by Type of Transplant, 1994-2007 Type of Transplant Commercial CadaverCommercial Live DonorLive DonorCadaver Interval (years)No.% SurvivalSENo.% SurvivalSENo.% SurvivalSENo.% SurvivalSE 199794%1%21294%2%39592%1%14677%3% 377089%1%17482%3%31288%2%10468%3% 550082%1%14472%3%25483%2%8063%4% 1016170%2%8651%4%9169%3%747%7% 123461%3%7045%4%4563%4%2-- No.=Number at riskSE=standard error Figure 5.5.4: Graft Survival by Type of Transplants, 1994-2007

22. Table 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 1994-2007) Year of Transplant1994-19992000-2007 (years)No.% SurvivalSENo.% SurvivalSE 1192981204951 3181961132942 516995286932 715994221932 No.=Number at riskSE=standard error Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 1994-2007)

23. Table 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 1994-2007) Year of Transplant1994-19992000-2007 (years)No.% SurvivalSENo.% SurvivalSE 1192912204932 3181862132912 516981386873 715976321804 SE=standard error Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 1994-2007)

24. Table 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant,1994-2007) Year of Transplant1994-19992000-2007 (years)No.% SurvivalSENo.% SurvivalSE 1335951663961 3317921453921 5289882211872 726285259852 No.=Number at riskSE=standard error Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1994-2007)

25. Table 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1994-2007) Year of Transplant1994-19992000-2007 Interval (years)No.% SurvivalSENo.% SurvivalSE 1335931663941 3317892453891 5289812211832 726274259783 No.=Number at riskSE=standard error Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1994-2007)

26. Table 5.6.1: Risk Factors for IHD in Renal Transplant Recipients at Year 2005, 2006 and 2007 200520062007 Diabetes19 (1.2)21 (1.4)25 (1.6) Hypertension**511 (33.4)456 (31.2)590 (37.5) CKD142 (9.3)177 (12.1)126 (8.0) Diabetes + Hypertension**160 (10.4)154 (10.5)174 (11.1) Diabetes + CKD20 (1.3)18 (1.2)11 (0.7) CKD + Hypertension**538 (35.1)490 (33.5)517 (32.8) Diabetes + CKD + Hypertension**142 (9.3)147 (10.0)131 (8.3) **Hypertension: BP systolic > 140 and BP diastolic > 90 OR have either Beta blocker / Calcium channel blocker / ACE inhibitor / AIIRB / Other anti-hypertensive drugs GFR (mL/min/1.73m2) = 1.2*(140-age(year))*weight(kg) / creatinine (µmol/L) if male GFR (mL/min/1.73m2) = 0.85*(1.2*(140-age(year))*weight(kg) / creatinine (µmol/L) if female CKD stage III-GFR, 30-60 CKD stage IV-GFR, 15-30 CKD stage V-GFR, <15 Figure 5.6.1 a: Venn Diagram for Pre and Post Transplant Complications (in %) at Year 2005

27. Figure 5.6.1 b: Venn Diagram for Pre and Post Transplant Complications (in %) at Year 2006 Figure 5.6.1 c: Venn Diagram for Pre and Post Transplant Complications (in %) at Year 2007

28. Table 5.6.2 a: Distribution of Patients by Systolic BP Levels, 2005-2007 200520062007 No.(%)No.(%)No.(%) Systolic BP<120233(14.25)249(15.64)239(14.18) Systolic BP <130318(19.45)395(24.81)392(23.26) Systolic BP 130-139475(29.05)483(30.34)529(31.39) Systolic BP 140-159452(27.65)353(22.17)409(24.27) Systolic BP 160-179133(8.13)93(5.84)99(5.88) Systolic BP >=18024(1.47)19(1.19)17(1.01) Figure 5.6.2 a: Distribution of Patients by Systolic BP Levels, 2005-2007

29. Table 5.6.2 b: Distribution of Patients by Diastolic BP Levels, 2005-2007 Year200520062007 No.(%)No.(%)No.(%) Diastolic BP<80522(31.93)624(39.20)697(41.36) Diastolic BP <85657(40.18)586(36.81)609(36.14) Diastolic BP 85-8973(4.46)73(4.59)74(4.39) Diastolic BP 90-99308(18.84)244(15.33)261(15.49) Diastolic BP 100-10965(3.98)61(3.83)39(2.31) Diastolic BP ≥11010(0.61)4(0.25)5(0.30) Figure 5.6.2 b: Distribution of Patients by Diastolic BP Levels, 2005-2007

30. Table 5.6.3: Distribution of Patients by CKD Stages, 2005-2007 200520062007 No.(%)No.(%)No.(%) CKD stage 1118(7.25)116(7.33)180(10.80) CKD stage 2579(35.59)534(33.73)593(35.57) CKD stage 3799(49.11)804(50.79)758(45.47) CKD stage 4112(6.88)107(6.76)113(6.78) CKD stage 519(1.17)22(1.39)23(1.38) Figure 5.6.3: Distribution of Patients by CKD Stages, 2005-2007

31. Table 5.6.4: Distribution of Patients by BMI Levels, 2005-2007 200520062007 No.(%)No.(%)No.(%) BMI <20254(15.54)243(15.26)253(15.01) BMI 20-25655(40.06)646(40.58)657(38.99) BMI 25-30515(31.50)497(31.22)534(31.69) BMI > 30211(12.91)206(12.94)241(14.30) Figure 5.6.4: Distribution of Patients by BMI Levels, 2005-2007

32. Table 5.6.5 a: Distribution of Patinets by LDL Levels, 2005-2007 200520062007 No.(%)No.(%)No.(%) LDL < 2.6418(25.57)492(30.90)527(31.28) LDL 2.6-3.4862(52.72)738(46.36)777(46.11) LDL ≥ 3.4355(21.71)362(22.74)381(22.61) Figure 5.6.5a: Distribution of Patients by LDL Levels, 2005-2007

33. Table 5.6.5 b: Distribution of Patients by Total Cholesterol Levels, 2005-2007 Year200520062007 No.(%)No.(%)No.(%) Total Cholesterol <4.1159(9.72)160(10.05)210(12.46) Total Cholesterol 4.1-5.1455(27.83)490(30.78)539(31.99) Total Cholesterol 5.1-6.2774(47.34)700(43.97)717(42.55) Total Cholesterol 6.2- 7.2173(10.58)173(10.87)159(9.44) Total Cholesterol > 7.274(4.53)69(4.33)60(3.56) Figure 5.6.5b: Distribution of Patients by Total Cholesterol Levels, 2005-2007

34. Table 5.6.5 c: Distribution of Patients by HDL Levels, 2005-2007 Year200520062007 No.(%)No.(%)No.(%) HDL <11187.221046.531086.41 HDL 1-1.330818.8430218.9635020.77 HDL >1.3120973.94118674.50122772.82 Figure 5.6.5c: Distribution of Patients by HDL Levels, 2005-2007

35. Table 5.6.6 a: Treatment for Hypertension, 2005-2007 YearNo. % on anti- hypertensives % on 1 anti- hypertensive drug % on 2 anti- hypertensives % on 3 anti- hypertensives 2005163585283019 2006159286342617 2007168585253121 Table 5.6.6 b: Distribution of Systolic BP without Anti-hypertensives, 2005-2007 YearNo.MeanSDMedianLQUQ % Patients = 160mmHg 2005229126.9151301201373 2006189123.814.41201171304 2007195125.316.51201141344 Table 5.6.6 c: Distribution of Diastolic BP without Anti-hypertensives, 2005-2007 YearNo.MeanSDMedianLQUQ% patients = 90mmHg 200522979980708018 200618976.410.380708011 200719576.61080708012 Table 5.6.6 d: Distribution of Systolic BP on Anti-hypertensives, 2005-2007 YearNo.MeanSDMedianLQUQ% Patients = 160mmHg 20051350134.517.313012014311 20061334131.716.31301201408 20071388132.6161301201408 Table 5.6.6 e: Distribution of Diastolic BP on Anti hypertensives, 2005-2007 YearNo.MeanSDMedianLQUQ% Patients = 90 mmHg 2005135080.89.480769025 2006133479.29.980708622 2007138779.19.680708520

36. Table 5.7.1: Cumulative Distribution of QoL-Index Score Transplant Recipient Patients 1998 - 2007 Dialysis modalityTX Number of patients1151 Centile 00 0.059 0.110 0.25 (LQ)10 0.5 (median)10 0.75 (UQ)10 0.910 0.9510 1 Figure 5.7.1: Cumulative Distribution of QoL-Index Score Transplant Recipient Patients 1998 - 2007

37. Table 5.7.2: Cumulative Distribution of QoL-Index Score in Relation to Diabetes Mellitus, Transplant Recipient Patients 1998 - 2007 Diabetes mellitusNoYes Number of patients990161 Centile 000 0.0598 0.1109 0.25 (LQ)10 0.5 (median)10 0.75 (UQ)10 0.910 0.9510 1 Figure 5.7.2: Cumulative Distribution of QoL-Index Score in Relation to Diabetes Mellitus, Transplant Recipient Patients 1998 – 2007

38. Table 5.7.3: Cumulative Distribution of QoL-Index Score in Relation to Gender, Transplant Recipient Patients 1998 – 2007 GenderMaleFemale Number of patients722429 Centile 000 0.0599 0.1109 0.25 (LQ)10 0.5 (median)10 0.75 (UQ)10 0.910 0.9510 1 Figure 5.7.3: Cumulative Distribution of QoL-Index Score in Relation to Gender, Transplant Recipient Patients 1998 – 2007

39. Age ≥60 Table 5.7.4: Cumulative Distribution of QoL-Index Score in Relation to Age, Transplant Recipient Patients 1998 – 2007 Age group (years)<2020-3940-59≥60 Number of patients9946451672 Centile 00000 0.059997 0.110 98 0.25 (LQ)10 9 0.5 (median)10 0.75 (UQ)10 0.910 0.9510 1 Figure 5.7.4: Cumulative Distribution of QoL-Index Score in Relation to Age, Transplant Recipient Patients 1998 – 2007 ≥ 60

40. Table 5.7.5: Cumulative Distribution of QoL-Index Score in Relation to Year of Entry, Transplant Recipient Patients 1998 – 2007 Year of Entry1998199920002001200220032004200520062007 Number of patients7210111012514313616713712337 Centile 00000000000 0.0510989989996 0.110 9 6 0.25 (LQ)10 0.5 (median)10 0.75 (UQ)10 0.910 0.9510 1 Figure 5.7.5: Cumulative Distribution of QoL-Index score in Relation to Year of Entry, Transplant Recipient Patients 1998 – 2007