1. Table 5.1.1: Stock and Flow of Renal Transplantation, 1997-2006 Year1997199819992000200120022003200420052006 New transplant patients127104127143161168160190162132 Died31262530373237414349 Graft failure38493632403841441935 Lost to follow up01192341674 Functioning graft at 31 st December1083111111761248133014251503159216841728

2. Figure 5.1.1: Stock and Flow of Renal Transplantation, 1975-2006

3. Table 5.1.2: New Transplant Rate per million population (pmp), 1997-2006 Year1997199819992000200120022003200420052006 New transplant patients127104127143161168160190162132 New transplant rate, pmp6566776765

4. Figure 5.1.2: New Transplant Rate, 1975-2006 New Transplant rate, pmp Year 0 1 2 3 4 5 6 7 8 9 10 1975197719791981198319851987198919911993199519971999200120032005

5. Table 5.1.3: Transplant Prevalence Rate per million population (pmp), 1997-2006 Year1997199819992000200120022003200420052006 Functioning graft at 31 st December1083111111761248133014251503159216841728 Transplant prevalence rate, pmp50 5253555860626465

6. Figure 5.1.3: Transplant Prevalence Rate, 1975-2006 Transplant Prevalence Rate, pmp Year 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 1975197719791981198319851987198919911993199519971999200120032005

7. Table 5.1.4: Place of Transplantation, 1997-2006 Year19971998199920002001 No.% % % % % HKL292333323628 203320 UMMC6577161319132314 Selayang Hospital00000043117 Other local0000113242 China80635048624980568251 India7677549674 Other overseas3233220011 Unknown2244540000 TOTAL127100104100127100143100161100 Year20022003200420052006TOTAL No.% % % % % HKL2817261620113220352733220 UMMC148647474541177 Selayang Hospital117 7 65375604 Other local1111215322191 China10261111691377210867755799261 India127431165375805 Other overseas0011210000131 Unknown0000000011121 TOTAL1681001601001901001621001321001625100

8. Table 5.2.1: Renal Transplant Recipients’ Characteristics, 1997-2006 Year1997199819992000200120022003200420052006 New Transplant Patients127104127143161168160190162132 Age at transplant (years), Mean3637 4041 42413837 Age at transplant (years), SD1211131413 1415 % Male64586264635766626968 % Diabetic (co-morbid / primary renal disease) 1110 15191522211920 % HBsAg positive5645578547 % Anti-HCV positive71811815910827

9. Table 5.2.2: Primary Causes of End Stage Renal Failure, 1997-2006 Year1997199819992000 No.% % % % New transplant patients127100104100127100143100 Glomerulonephritis3024282741324934 Diabetes Mellitus97551081611 Hypertension5455761813 Obstructive uropathy32444332 ADPKD22111132 Drugs/toxic nephropathy00000000 Hereditary nephritis00000000 Unknown6450555362495438 Others181410 65128 Year200120022003200420052006 No.% % % % % % New transplant patients161100168100160100190100162100132100 Glomerulonephritis422653325434623346284836 Diabetes Mellitus231416102616321727172116 Hypertension171124142516512738232821 Obstructive uropathy322121423243 ADPKD113253533211 Drugs/toxic nephropathy000021210000 Hereditary nephritis000000110000 Unknown613868405836834450314131 Others2314159128271417101511

10. Table 5.3.1: Type of Renal Transplantation, 1997-2006 Year19971998199920002001 No.% % % % % Commercial Cadaver81665152625180568251 Commercial Live Donor7644439664 Live Donor (genetically related)272227 403321153220 Live Donor (emotionally related)0022546442 Cadaver8715 10827193723 TOTAL12310099100121100143100161100 Year20022003200420052006 No.% % % % % Commercial Cadaver102611127014276105657859 Commercial Live Donor11732538543 Live Donor (genetically related)30182516211137232217 Live Donor (emotionally related)3253213243 Cadaver2213159179962418 TOTAL168100160100187100162100132100 *Commercial Cadaver (China, India, other oversea) *Commercial live donor (living unrelated) *Cadaver (local)

11. Table 5.3.2: Biochemical Data, 2004-2006 Biochemical parameters Summary200420052006 Creatinine, umol/L No.155016341592 Mean132.1133.7135.7 SD63.865.581.4 Median120 Minimum383542 Maximum8177631152 Hb, g/dL No.155016341592 Mean12.912.812.7 SD1.9 Median12.9 12.8 Minimum4.95.53.3 Maximum19.71919.8 Albumin, g/L No.155016341592 Mean39.439.5 SD10.50.7 Median39.4 Minimum223429 Maximum504648 Calcium, mmol/L No.155016341592 Mean2.42.3 SD0.2 Median2.3 Minimum1.11.21.1 Maximum3.3 3.1 Phosphate, mmol/L No.155016341592 Mean1.1 SD0.2 Median1.1 Minimum0.3 0.4 Maximum2.73.33.5 Alkaline Phosphate (ALP), U/L No.155016341592 Mean79.578.978.7 SD46.546.643.5 Median73 71 Minimum10186.3 Maximum994831700

12. Biochemical parameters Summary200420052006 ALT, U/L No.155016341592 Mean31.430.829.9 SD32.63130.4 Median252422 Minimum444 Maximum563613433 Total cholesterol, mmol/L No.155016341592 Mean5.55.45.3 SD1.11 Median5.4 Minimum2.62.12 Maximum2013.114.7 LDL cholesterol, mmol/L No.155016341592 Mean3.133 SD0.70.8 Median333 Minimum10.91 Maximum8.59.211.1 HDL cholesterol, mmol/L No.155016341592 Mean1.6 SD0.40.5 Median1.6 Minimum0.2 Maximum4.35.65.8 Systolic Blood Pressure, mmHg No.155016341592 Mean132.2133.3130.8 SD15.916.915.9 Median130 Minimum80 66 Maximum200220210 Diastolic Blood Pressure, mmHg No.155016341592 Mean80.380.578.9 SD9.69.29.8 Median80 Minimum405030 Maximum121127120 Table 5.3.2: Biochemical Data, 2004-2006

13. Table 5.3.3: Medication Data, 2004-2006 Medication dataSingle drug treatmentCombined drug treatment 200420052006200420052006 No.% % % % % % All patients 141610015621001477100141610015621001477100 (i) Immunosuppressive drug(s) treatment Prednisolone 13112181139498152898143997 Azathioprine 001000603436053949634 Cyclosporine 404050113580122178111575 Tacrolimus (FK506) 000000185132241425417 Mycophenolate Mofetil (MMF) 100000524376824470548 Rapamycin 000000508160 Others 100000161101181 (ii) Non-Immunosuppressive drug(s) treatment Beta blocker 10471057775650466674359640 Calcium channel blocker 188131951219913795568225378553 ACE inhibitor 352604393272193422229220 AIIRB 111201272765160101409 Anti-lipid 74567415510567406013867546 Other anti-hypertensive 505011113091581015911

14. Table 5.4.1: Post Transplant Complications, 2004-2006 Post transplant complications Complication developed before transplant (regardless of complication after transplantation) Complication developed only after transplantation 200420052006200420052006 No.% % % % % % All patients155010016341001592100155010016341001592100 Diabetes (either as primary renal disease or co-morbid) 190122161321113126812381268 Cancer302020171191201 Cardiovascular disease + cerebrovascular disorder 825785735835453 3 Hypertension100565104664103165396264382735622 * Hypertension: BP systolic > 140 and BP diastolic > 90 mmHg OR had either Beta blocker / Calcium channel blocker / ACE inhibitor / AIIRB / Other anti-hypertensive

15. Table 5.4.2: Transplant Patients Death Rate and Graft Loss, 1997-2006 Year1997199819992000200120022003200420052006 No. at risk1054109711441212128913781464154816381706 Transplant death31262530373237414349 Transplant death rate %3222323333 Graft loss38493632403841441935 Graft loss rate %4433333312 Acute rejection0000003191417 Acute rejection rate %0000000111 All losses69756162777078856284 All losses rate %7755656756 *Graft loss=graft failure *All losses=death / graft loss (acute rejection happens concurrently with graft failure / death)

16. Figure 5.4.2(i): Transplant Recipient Death Rate, 1975-2006 Death rate (%) Year 0 10 20 30 40 50 60 70 197519771979198119831985198719891991 1993 199519971999200120032005

17. Figure 5.4.2(ii): Transplant Recipient Graft Loss Rate, 1975-2006 Graft loss rate (%) Year 0 2 4 6 8 10 12 14 16 18 1975197719791981198319851987198919911993199519971999200120032005

18. Table 5.4.3: Causes of Death in Transplant Recipients, 1997-2006 Year1997199819992000200120022003200420052006 No.% % % % % % % % % % Cardiovascular41331141310297165 923495111019 Died at home26415619135125165136 511713 Infection14451037723123520479281128112422502241 Graft failure13000026000000240000 Cancer00311310266144136158184947 Liver disease262731013123925373747 Accidental death 00001313121300000000 Others4132751639253951310223747 Unknown4133112626122625122536 TOTAL31100271003110034100431003210040100451004410054100 Note: Some patients may have more than one cause of death.

19. Table 5.4.4: Causes of Graft Failure, 1997-2006 Year1997199819992000200120022003200420052006 No.% % % % % % % % % % Rejection2154285323641959256122552048317115752671 Calcineurin toxicity00000000000000000013 Other drug toxicity13000000000000000000 Ureteric obstruction00000000000000000000 Infection00120013250025121525 Vascular causes410361339120037492 38 Recurrent/de novo renal disease 13120000252512120013 Others5135900260041012001525 Unknown718152812337221127123015367161525 TOTAL39100531003610032100411004010042100441002010037100 Some patients may have more than one cause of graft failure.

20. Table 5.5.1: Patient Survival, 1993-2006 Interval (years)No.% SurvivalSE 11781951 31344911 5972881 10349801 SE=standard error

21. Figure 5.5.1: Patient Survival, 1993-2006 Cumulative survival Duration in years 024681012 0.00 0.25 0.50 0.75 1.00

22. Table 5.5.2: Graft survival, 1993-2006 Interval (years)No.% survivalSE 11781921 31344851 5972791 10349631 SE=standard error

23. Figure 5.5.2: Graft Survival, 1993-2006 Cumulative survival Duration in years 024681012 0.00 0.25 0.50 0.75 1.00

24. Table 5.5.3: Patient Survival by Type of Transplant, 1993-2006 Type of TransplantCommercial CadaverCommercial Live DonorLive DonorCadaver Interval (years)No.% SurvivalSENo.% SurvivalSENo.% SurvivalSENo.% SurvivalSE 1938961285961398971131842 3661921240901323951100793 542987120387225294171764 10118822126723999027705 SE=standard error

25. Figure 5.5.3: Patient Survival by Type of Transplant, 1993-2006 Cumulative survival Duration in years 024681012 0.00 0.25 0.50 0.75 1.00 Commercial cadaver Commercial live donor Live donor Cadaver

26. Table 5.5.4: Graft Survival by Type of Transplant, 1993-2006 Type of TransplantCommercial CadaverCommercial Live DonorLive DonorCadaver Interval (years)No.% SurvivalSENo.% SurvivalSENo.% SurvivalSENo.% SurvivalSE 1938941285931398921131763 3661891240822323882100684 542982120373225283271644 10118702126523996937468 SE=standard error

27. Figure 5.5.4: Graft Survival by Type of Transplant, 1993-2006 Cumulative survival Duration in years 024681012 0.00 0.25 0.50 0.75 1.00 Commercial cadaver Commercial live donor Live donor Cadaver

28. Table 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 1993-2006) Year of Transplant1993-19981999-2006 Interval (years)No.% SurvivalSENo.% SurvivalSE 1181971218961 3169952155951 515993294951 714791237951 SE=standard error

29. Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 1993-2006) Cumulative survival Duration in years 01234567 0.00 0.25 0.50 0.75 1.00 Year 1993-1998 Year 1999-2006

30. Table 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 1993-2006) Year of Transplant1993-19981999-2006 Interval (years)No.% SurvivalSENo.% SurvivalSE 1181882218941 3169833155922 515978394892 714773337833 SE=standard error

31. Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 1993-2006) Cumulative survival Duration in years 01234567 0.00 0.25 0.50 0.75 1.00 Year 1993-1998 Year 1999-2006

32. Table 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1993-2006) Year of Transplant1993-19981999-2006 Interval (years)No.% SurvivalSENo.% SurvivalSE 1289941650961 3276922385921 5248872181872 722683250852 SE=standard error

33. Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1993-2006) Cumulative survival Duration in years 01234567 0.00 0.25 0.50 0.75 1.00 Year 1993-1998 Year 1999-2006

34. Table 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1993-2006) Year of Transplant1993-19981999-2005 Interval (years)No.% SurvivalSENo.% SurvivalSE 1289931650951 3276892385891 5248802181832 722674350783 SE=standard error

35. Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1993-2006) Cumulative survival Duration in years 01234567 0.00 0.25 0.50 0.75 1.00 Year 1993-1998 Year 1999-2006

36. Table 5.6.1: Risk Factors for IHD in Renal Transplant Recipients at Year 2004, 2005, and 2006 200420052006 No. (%) Diabetes27 (1.8)19 (1.2)21 (1.4) Hypertension**503 (34.2)511 (33.4)460 (31.4) CKD121 (8.2)142 (9.3)177 (12.1) Diabetes + Hypertension**147 (10.0)159 (10.4)152 (10.4) Diabetes + CKD21 (1.4)20 (1.3)18 (1.2) CKD + Hypertension**529 (36.0)539 (35.2)489 (33.4) Diabetes + CKD + Hypertension**121 (8.2)141 (9.2)146 (10.0) ** Hypertension: BP systolic > 140 and BP diastolic > 90 mmHg OR had 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 mL/min CKD stage IV – GFR, 15- 30 mL/min CKD stage V – GFR, < 15 mL/min

37. Figure 5.6.1a: Venn Diagram for Pre and Post Transplant Complications (in %) at year 2004 8.2 10.0 36.01.4 34.2 8.2 1.8 Diabetes Hypertension

38. Figure 5.6.1b: Venn Diagram for Pre and Post Transplant Complications (in %) at Year 2005 9.2 1.3 35.2 10.4 9.3 1.2 33.4 CKD Diabetes Hypertension

39. Figure 5.6.1c: Venn Diagram for Pre and Post Transplant Complications (in %) at Year 2006 10.0 1.2 33.4 10.4 12.1 1.4 31.4 DiabetesHypertension CKD

40. Table 5.6.2a: Distribution of Patients by Systolic BP Levels, 2004-2006 200420052006 No. (%) Systolic BP <120207 (13.4)233 (14.3)249 (15.6) Systolic BP <130341 (22.0)318 (19.5)395 (24.8) Systolic BP 130-139459 (29.6)474 (29.0)483 (30.3) Systolic BP 140-159418 (27.0)452 (27.7)353 (22.2) Systolic BP 160-179102 (6.6)133 (8.1)93 (5.8) Systolic BP ≥ 18023 (1.5)24 (1.5)19 (1.2)

41. Figure 5.6.2a: Distribution of Patients by Systolic BP Levels, 2004-2006 Year Percentage of patients (%) 0 10 20 30 40 50 60 70 80 90 100 Systolic BP <120 Systolic BP <130 Systolic BP 130-139 Systolic BP 140-159 Systolic BP 160-179 Systolic BP >=180 200420052006

42. Table 5.6.2b: Distribution of Patients by Diastolic BP Levels, 2004-2006 200420052006 No. (%) Diastolic BP<80513 (33.1)521 (31.9)624 (39.2) Diastolic BP<85602 (38.8)657 (40.2)586 (36.8) Diastolic BP 85-8948 (3.1)73 (4.5)73 (4.6) Diastolic BP 90-99319 (20.6)308 (18.8)244 (15.3) Diastolic BP 100-10956 (3.6)65 (4.0)61 (3.8) Diastolic BP ≥ 11012 (0.8)10 (0.6)4 (0.3)

43. Figure 5.6.2b: Distribution of Patients by Diastolic BP Levels, 2004-2006 Percentage of patients (%) Year 0 10 20 30 40 50 60 70 80 90 100 Diastolic BP <80 Diastolic BP <85 Diastolic BP 85-89 Diastolic BP 90-99 Diastolic BP 100-109 Diastolic BP ≥110 200420052006

44. Table 5.6.3: Distribution of Patients by CKD Stages, 2004-2006 200420052006 No. (%) CKD stage 1130 (8.4)126 (7.7)126 (7.9) CKD stage 2571 (36.8)579 (35.4)533 (33.5) CKD stage 3727 (46.9)798 (48.8)804 (50.5) CKD stage 4109 (7.0)112 (6.9)107 (6.7) CKD stage 513 (0.8)19 (1.2)22 (1.4)

45. Figure 5.6.3: Distribution of Patients by CKD Stages, 2004-2006 Percentage of patients (%) Year 0 10 20 30 40 50 60 70 80 90 100 CKD Stage 1 CKD Stage 2 CKD Stage 3 CKD Stage 4 CKD Stage 5 200420052006

46. Table 5.6.4: Distribution of Patients by BMI Levels, 2004-2006 200420052006 No. (%) BMI <20243 (15.7)255 (15.6)243 (15.3) BMI 20-25609 (39.3)654 (40.0)647 (40.6) BMI 25-30500 (32.3)514 (31.5)497 (31.2) BMI >30198 (12.8)211 (12.9)205 (12.9)

47. Figure 5.6.4: Distribution of Patients by BMI Levels, 2004-2006 Percentage of patients (%) Year 0 10 20 30 40 50 60 70 80 90 100 BMI <20 BMI 20-25 BMI 25-30 BMI >30 200420052006

48. Table 5.6.5a: Distribution of Patients by LDL Levels, 2004-2006 200420052006 No. (%) LDL < 2.6280 (18.1)411 (25.2)478 (30.0) LDL 2.6-3.4946 (61.0)868 (53.1)753 (47.3) LDL >= 3.4324 (20.9)355 (21.7)361 (22.7)

49. Figure 5.6.5a: Distribution of Patients by LDL Levels, 2004-2006 Percentage of patients (%) Year 0 10 20 30 40 50 60 70 80 90 100 LDL <2.6 LDL 2.6-3.4 LDL >= 3.4 200420052006

50. Table 5.6.5b: Distribution of Patients by Total Cholesterol Levels, 2004-2006 200420052006 No. (%) Total Cholesterol <4.1111 (7.2)156 (9.5)155 (9.7) Total Cholesterol 4.1-5.1413 (26.6)455 (27.8)489 (30.7) Total Cholesterol 5.2-6.2753 (48.6)776 (47.5)706 (44.3) Total Cholesterol 6.3- 7.2197 (12.7)173 (10.6)173 (10.9) Total Cholesterol > 7.276 (4.9)74 (4.5)69 (4.3)

51. Figure 5.6.5b: Distribution of Patients by Total Cholesterol Levels, 2004-2006 Percentage of patients (%) Year 0 10 20 30 40 50 60 70 80 90 100 Total Cholesterol <4.1 Total Cholesterol 4.1-5.1 Total Cholesterol 5.1-6.2 Total Cholesterol 6.2-7.2 Total Cholesterol >7.2 200420052006

52. Table 5.6.5c: Distribution of Patients by HDL Levels, 2004-2006 200420052006 No. (%) HDL <186 (5.5)116 (7.1)102 (6.4) HDL 1-1.3255 (16.5)308 (18.8)302 (19.0) HDL >1.31209 (78.0)1210 (74.1)1188 (74.6)

53. Figure 5.6.5c: Distribution of Patients by HDL Levels, 2004-2006 Percentage of patients (%) Year 0 10 20 30 40 50 60 70 80 90 100 HDL <1 HDL, 1-1.3 HDL >1.3 200420052006

54. Table 5.6.6a: Treatment for Hypertension, 2004 – 2006 YearNo. % on anti-hypertensives % on 1 anti-hypertensive drug % on 2 anti-hypertensives % on 3 anti-hypertensives 2004155087303418 2005163485283019 2006159286342617 YearNo.MeanSDMedianLQUQ % Patients ≥ 160 mmHg 2004179126141301201304 2005229127151301201373 2006189124141201171304 YearNo.MeanSDMedianLQUQ % Patients ≥ 90 mmHg 200417979980738017 200522979980708018 2006189761080708011 Table 5.6.6b: Distribution of Systolic BP without Anti-hypertensives, 2004-2006 Table 5.6.6c: Distribution of Diastolic BP without Anti-hypertensives, 2004-2006

55. Table 5.6.6d: Distribution of Systolic BP on Anti-hypertensives, 2004-2006 YearNo.MeanSDMedianLQUQ % Patients ≥ 160 mmHg 20041312133161301201409 200513501341713012014311 20061334132161301201408 Table 5.6.6e: Distribution of Diastolic BP on Anti-hypertensives, 2004-2006 YearNo.MeanSDMedianLQUQ % Patients ≥ 90 mmHg 20041312811080749027 2005135081980769025 20061334791080708622