Ntr 2008 by Derma Organ

FIFTH REPORT OF THE NATIONAL TRANSPLANT REGISTRY 2008

Editors Hooi LS Lela Yasmin Mansor

With contributions by: Alan Teh KH, Chan LL, Shamala R, Chandramalar S, Mohamed Ezani, David Chew SP, Ashari Yunus, Ganesalingam K, Goh BL, Suzina Sheikh

August 2010 ﾂ年ational Transplant Registry, Malaysia ISSN 1823-5719

Published by:

National Transplant Registry Level 5, Menara Wisma Sejarah 230, Jalan Tun Razak 50400 Kuala Lumpur Malaysia Tel

: (603) 2681 5948

Fax

: (603) 2681 5949

e-mail : ntr@acrm.org.my Website: http://www.mst.org.my This report is copyrighted. However it may be freely reproduced without the permission of the National Transplant Registry. Acknowledgement would be appreciated. Suggested citation of this report is as follows: Hooi LS, Lela Yasmin Mansor (Eds). Fifth Report of the National Transplant Registry Malaysia 2008. Kuala Lumpur 2010.

The electronic version of this report can be downloaded at: http://www.mst.org.my/ntrSite

Disclaimer There is a potential that data for previous years printed in this report are different from what were printed in previous reports. This is because analysis for this report is based on the latest dataset in the web which may have been updated by SDP.

FORWARD It is with great pleasure that the Malaysian Society of Transplantation presents the 5th Annual Report (2008) of the National Transplant Registry containing updated data and statistics on the entire range of transplant activities, from organ donation to transplantation, and its outcomes. Registries are the cornerstone of any clinical system and are the key to monitoring the performance of the system. The National Transplant Registry was established in 2003 by the combined efforts of the Malaysian Society of Transplantation and the Ministry of Health Malaysia to collect and maintain a database of all transplant related activities in Malaysia. This database serves as an important national resource of transplant related information and helps in planning the development and delivery of future transplant services for the benefit of all Malaysians. The NTR is an incredible resource of information for clinicians, researchers, health care planners and administrators. It helps us to better understand the need for transplantation and the need to improve the clinical care and overall clinical outcomes for all individuals who have had an organ or tissue transplant. The data provided by each transplant programme is verified and analysed as a whole and can be viewed online at http://www.mst.org.my. I would like to thank Dr. Hooi Lai Seong, Datin Dr. Lela Yasmin Mansor and the various expert panels for their ongoing support and commitment to the registry in preparing, editing and proof reading this report. I would also like to thank all the source data providers from the public and private hospitals and university medical centres for collaborating and contributing their data to the National Transplant Registry over the years. The credit for the strength of our transplant registry goes entirely to the diligence of the transplant registry staff that have painstakingly dissected and verified the medical information to provide exceptional quality data. A special thanks to the members of the Expert Panels, the Transplant Registry Unit and the Governance Board for their tremendous contributions to the success of this registry. It is hoped that with the continued cooperation and participation of all parties involved, it will be possible to ensure that the data remains available and worthy for studies in the future. It is thus vital that the quality of the data and the integrity of the current database be maintained and supported for these purposes. I hope that in the coming years we will be able to secure adequate funding for the registry to go online in real time. A web-based registry will be able to seamlessly integrate and provide data of the various transplant activities in the country readily at any given point in time.

Datuk (Mr) Harjit Singh MBBS; FRCS Ed; FRCSI President, Malaysian Society of Transplantation

ACKNOWLEDGEMENTS The National Transplant Registry would like to record its appreciation to everyone who have helped made this report possible. We would especially like to thank the following: x

Our source data providers that are the transplant surgeons, physicians and staff of all organ and tissue transplant centres and transplant follow up centres from the government, universities and private sectors, without whose commitment, hard work and timely data submission, there will be no report

National Renal Registry for sharing the renal transplant data

Clinical Research Centre, Hospital Kuala Lumpur

Ministry of Health, Malaysia

The members of the various expert panels for their expertise and for devoting their valuable time and effort in preparing and writing the various chapters

Information technology personnel namely Ms Lim Jie Ying (database administrator), Mr Sebastian Thoo (programmer), Mr Rakesh A/L M. Jaya Prakasam (web application programmer) and Ms Azizah Alimat (desktop publisher)

Statistician Ms Lena Yeap Lay Ling

Roche (M) Sdn. Bhd. for their financial contribution to the registry yearly

Many others, whose names are not listed here, for their support.

PARTICIPATING CENTRES Discipline: Blood and Marrow Transplant 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Ampang Puteri Specialist Hospital Division of Haematology, Department of Medicine, University of Malaya Medical Centre Haematology Department, Hospital Ampang Haematology Department, Sime Darby Medical Centre Subang Jaya Haemapoietic Stem Cell Transplant Unit, Hospital Universiti Sains Malaysia Maybank BMT Centre, Universiti Kebangsaan Malaysia Medical Centre Oncology-Haematology Department, Gleneagles Medical Centre, Penang Oncology-Haematology Department, Lam Wah Ee Hospital Paediatric BMT Unit, Department of Paediatrics, University of Malaya Medical Centre Paediatric BMT Unit, Institute of Paediatrics, Hospital Kuala Lumpur Paediatric BMT Unit, Sime Darby Medical Centre Subang Jaya

Discipline: Bone and Tissue Transplant 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

Bone Bank, Hospital Kuala Lumpur Bone Bank, University of Malaya Medical Centre Department of Orthopaedic & Traumatology, Hospital Kangar Department of Orthopaedic Surgery, Hospital Sultanah Bahiyah Department of Orthopaedic Surgery, Hospital Taiping Department of Orthopaedic Surgery, University of Malaya Medical Centre Department of Orthopaedics, Hospital Ipoh Department of Orthopaedics, Hospital Kajang Department of Orthopaedics, Hospital Kuantan Department of Orthopaedics, Hospital Pulau Pinang Department of Orthopaedics, Hospital Raja Perempuan Zainab II Department of Orthopaedics, Hospital Seberang Jaya Department of Orthopaedics, Hospital Sultanah Aminah Department of Orthopaedics, Hospital Sultanah Nur Zahirah Department of Orthopaedics, Hospital Tengku Ampuan Rahimah Department of Orthopaedics, Hospital Universiti Sains Malaysia Department of Orthopaedics, Sarawak General Hospital Department of Orthopaedics, Sultanah Fatimah Specialist Hospital Department of Orthopaedics, Traumatology and Rehabilitation, International Islamic University Malaysia 20. Department of Surgery, Hospital Raja Perempuan Zainab II 21. Hospital Fatimah, Ipoh 22. Institute of Orthopaedic & Traumatology, Hospital Kuala Lumpur 23. Island Hospital, Penang 24. Kota Bharu Medical Centre 25. Malaysian Nuclear Agency 26. National Tissue Bank, Universiti Sains Malaysia 27. Normah Medical Specialist Centre, Kuching 28. Ophthalmology Department, Hospital Kuala Lumpur 29. Ophthalmology Department, Hospital Sultanah Bahiyah 30. Ophthalmology Department, Hospital Sungai Buloh 31. Ophthalmology Department, Hospital Teluk Intan iii

Discipline: Bone and Tissue Transplant 32. Ophthalmology Department, Hospital Tengku Ampuan Afzan 33. Ophthalmology Department, Hospital Tengku Ampuan Rahimah 34. Ophthalmology Department, Hospital Universiti Sains Malaysia 35. Ophthalmology Department, Sri Kota Medical Centre 36. Timberland Medical Centre, Kuching 37. Wan Orthopaedic, Trauma & Sports Injury Centre, Seremban Specialist Hospital Discipline: Cornea Transplant 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40.

Eye Clinic, Mahkota Medical Centre Hope Eye Centre, Gleneagles Intan Medical Centre, Kuala Lumpur International Specialist Eye Centre, Kuala Lumpur K.C. Yeo Eye Specialist Centre, Melaka Ophthalmology Department, 94 Hospital Angkatan Tentera Kem Terendak Ophthalmology Department, Gleneagles Medical Centre, Penang Ophthalmology Department, Hospital Batu Pahat Ophthalmology Department, Hospital Bukit Mertajam Ophthalmology Department, Hospital Duchess of Kent Ophthalmology Department, Hospital Ipoh Ophthalmology Department, Hospital Kangar Ophthalmology Department, Hospital Kuala Lipis Ophthalmology Department, Hospital Kuala Lumpur Ophthalmology Department, Hospital Kuala Pilah Ophthalmology Department, Hospital Melaka Ophthalmology Department, Hospital Mentakab Ophthalmology Department, Hospital Miri Ophthalmology Department, Hospital Pakar Sultanah Fatimah Ophthalmology Department, Hospital Pantai Indah Ophthalmology Department, Hospital Pulau Pinang Ophthalmology Department, Hospital Putrajaya Ophthalmology Department, Hospital Queen Elizabeth, Kota Kinabalu Ophthalmology Department, Hospital Raja Perempuan Zainab II Ophthalmology Department, Hospital Selayang Ophthalmology Department, Hospital Sibu Ophthalmology Department, Hospital Sultan Ismail Pandan Ophthalmology Department, Hospital Sultanah Aminah Ophthalmology Department, Hospital Sultanah Bahiyah Ophthalmology Department, Hospital Sultanah Nur Zahirah Ophthalmology Department, Hospital Sungai Buloh Ophthalmology Department, Hospital Sungai Petani Ophthalmology Department, Hospital Taiping Ophthalmology Department, Hospital Tawau Ophthalmology Department, Hospital Teluk Intan Ophthalmology Department, Hospital Tengku Ampuan Afzan Ophthalmology Department, Hospital Tengku Ampuan Rahimah Ophthalmology Department, Hospital Tuanku Jaâ&#x20AC;&#x2122;afar Ophthalmology Department, Hospital Umum Sarawak Ophthalmology Department, Hospital Universiti Kebangsaan Malaysia Ophthalmology Department, Hospital Universiti Sains Malaysia iv

Discipline: Cornea Transplant 41. 42. 43. 44. 45. 46. 47.

Ophthalmology Department, Sri Kota Medical Centre Ophthalmology Department, University of Malaya Medical Centre Pusat Pakar Mata Centre For Sight, PJ Puteri Specialist Hospital, Johor Bahru Sunway Medical Centre Tan Eye Specialist Centre, Sunway Medical Centre Tun Hussein Onn National Eye Hospital

Discipline: Heart and Lung Transplant 1. 2.

Cardiothoracic Department, Institut Jantung Negara Institut Perubatan Respiratori, Hospital Kuala Lumpur

Discipline: Heart Valve Transplant 1.

Cardiovascular Tissue Bank, Department of Cardiothoracic Surgery, Institut Jantung Negara

Discipline: Liver Transplant 1. 2. 3. 4. 5.

Department of Paediatrics, University of Malaya Medical Centre Hepatobiliary Department, Hospital Selayang Paediatric Hepatology Unit, Hospital Selayang Institute of Paediatrics, Hospital Kuala Lumpur Sime Darby Medical Centre Subang Jaya

Discipline: Renal Transplant 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.

C. S. Loo Kidney & Medical Specialist Centre Damai Medical & Heart Clinic Fan Medical Renal Clinic Kidney Unit, Assunta Hospital Klinik Dr Choo & Liew Nephrology Clinic (Renal Transplant), Hospital Kuala Lumpur Nephrology Clinic (Renal Transplant), Hospital Kuala Lumpur (Paed) Renal Transplant Clinic, Hospital Batu Pahat Renal Transplant Clinic, Hospital Bintulu Renal Transplant Clinic, Hospital Duchess of Kent Renal Transplant Clinic, Hospital Dungun Renal Transplant Clinic, Hospital Kemaman Renal Transplant Clinic, Hospital Kluang Renal Transplant Clinic, Hospital Labuan Renal Transplant Clinic, Hospital Likas Renal Transplant Clinic, Hospital Melaka Renal Transplant Clinic, Hospital Mersing Renal Transplant Clinic, Hospital Miri v

Discipline: Renal Transplant 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57.

Renal Transplant Clinic, Hospital Pakar Sultanah Fatimah Renal Transplant Clinic, Hospital Pantai Penang Renal Transplant Clinic, Hospital Pontian Renal Transplant Clinic, Hospital Pulau Pinang Renal Transplant Clinic, Hospital Queen Elizabeth Renal Transplant Clinic, Hospital Raja Perempuan Zainab II Renal Transplant Clinic, Hospital Raja Permaisuri Bainun Renal Transplant Clinic, Hospital Segamat Renal Transplant Clinic, Hospital Selayang Renal Transplant Clinic, Hospital Serdang Renal Transplant Clinic, Hospital Sibu Renal Transplant Clinic, Hospital Sultan Ismail Renal Transplant Clinic, Hospital Sultanah Aminah Renal Transplant Clinic, Hospital Sultanah Bahiyah Renal Transplant Clinic, Hospital Sultanah Nur Zahirah Renal Transplant Clinic, Hospital Taiping Renal Transplant Clinic, Hospital Tawau Renal Transplant Clinic, Hospital Tengku Ampuan Afzan Renal Transplant Clinic, Hospital Tengku Ampuan Rahimah Renal Transplant Clinic, Hospital Tuanku Jaâ&#x20AC;&#x2122;afar Renal Transplant Clinic, KPJ Ampang Puteri Specialist Hospital Renal Transplant Clinic, KPJ Selangor Specialist Hospital Renal Transplant Clinic, Normah Medical Specialist Centre Renal Transplant Clinic, Prince Court Medical Centre Renal Transplant Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia Renal Transplant Clinic, Renal Care (Ipoh Specialist Hospital) Renal Transplant Clinic, Sabah Medical Centre Renal Transplant Clinic, Sarawak General Hospital Renal Transplant Clinic, Selangor Medical Centre Renal Transplant Clinic, Sime Darby Medical Centre Subang Jaya Renal Transplant Clinic, Sri Kota Medical Centre Renal Transplant Clinic, Sunway Medical Centre Renal Transplant Clinic, Universiti Sains Malaysia Hospital Renal Transplant Clinic, University Malaya Medical Centre Renal Transplant Clinic (Paed), Ward 8C&D, Hospital Sultan Ismail Simon Wong Medical & Kidney Clinic, Timberland Medical Centre Smartcare Dialysis Centre, Subang Jaya Tan Medical Renal Clinic Wee Kidney & Medical Specialist Clinic

ABOUT THE NATIONAL TRANSPLANT REGISTRY The National Transplant Registry (NTR) is a Ministry of Health (MOH) supported registry whose aim is to collect information about organ and tissue transplantations in Malaysia. The information allows us to estimate the magnitude of transplant activity in the country. Such information besides being useful to transplantation practitioners may be used in assisting the MOH, non-governmental organisations, private providers and industry in program planning and evaluation of transplantation services. The objectives of NTR are to: 1. Determine the frequency and distribution of all types of transplantation activity in Malaysia. 2. Determine the outcomes of transplantation. 3. Determine the factors influencing outcomes of transplantation. 4. Evaluate transplantation services in the country. 5. Stimulate and facilitate research on transplantation and its management. The NTR receives data on organ / tissue transplantation from 3 main sources: 1. The individual doctors who provide transplantation services, who voluntarily report data to the NTR. Data collection will be from seven main types of transplantation services: x Blood and Marrow Transplant x Cornea Transplant x Heart and Lung Transplant x Liver Transplant x Renal Transplant x Heart Valve Transplant x Bone and Tissue Transplant 2. The National Vital Registration system (Jabatan Pendaftaran Negara). Their data is useful for determining or verifying mortality outcomes of transplant patients. 3. Information Documentation Unit of the MOH, which operates the Health Management Information System (HMIS). NTR SPONSORS x x x x

Medical Development Division, MOH National Transplant Coordinating Committee Malaysian Society Of Transplantation Clinical Research Centre, Hospital Kuala Lumpur

vii

GOVERNANCE BOARD The Governance Board is established to govern the NTR and the terms of reference are as follows: 1. Provide the necessary leadership and direction for the National Transplant Registry. 2. Ensure that the vision, objectives and goals of the National Transplant Registry are clearly established and that strategies are in place for achieving them. 3. Establish policies and procedures for the proper functioning of the National Transplant Registry. 4. Seek input and feedback from all stakeholders and end users with regards to their expectations and the performance of the National Transplant Registry. 5. Secure funding and financial support for the National Transplant Registry. 6. Galvanize the commitment of all interested parties to the National Transplant Registry. 7. Receive and review the annual report from the steering committee. Current members of the Governance Board are as follows: Chairperson Dato’ Dr Zaki Morad Mohd Zaher Vice Chairperson Datin Dr Fadhilah Zowyah Lela Yasmin Mansor Members: Datuk (Mr) Harjit Singh Dr Teng Seng Chong Tan Sri Dato’ Seri Dr Mohd. Ismail Merican Mr Rohan Malek Dr Hooi Lai Seong Dr Aizai Azan Abdul Rahim Dr Suzina Sheikh Ab. Hamid Dr Abdul Malik Hussein Dr Tan Chwee Choon Dato’ Dr Chang Kian Meng Dato’ Dr M.Venugopal Balchand Dr Goh Pik Pin Dr Jamaiyah Haniff

Secretariat: Ms Leong Wei Chee viii

Malaysian Society of Transplantation Medical Development Division, Ministry of Health Malaysian Liver Foundation Malaysian Urological Association Malaysian Society of Nephrology National Heart Association of Malaysia Malaysian National Tissue Bank Malaysian Orthopaedic Association National Kidney Foundation of Malaysia Malaysian Society of Haematology Malaysian Association of Thoracic & Cardiovascular Surgeons Clinical Research Centre, Hospital Kuala Lumpur & Malaysian Society of Ophthalmology Clinical Research Centre, Hospital Kuala Lumpur

EXPERT PANEL NTR has established seven groups of Expert Panel comprising members of the medical profession and allied health with expert knowledge in these various disciplines: x x x x x x x

Blood and Marrow Transplant Cornea Transplant Heart and Lung Transplant Liver Transplant Renal Transplant Heart Valve Transplant Bone and Tissue Transplant

The role of the Expert Panel is: 1. To undertake quality control of the clinical registry form and the data dictionary as deemed necessary. 2. To undertake quality control of the reported data. 3. To undertake literature review on the relevant area. 4. To interpret the results generated by NTR’s statisticians. 5. To write the section of the NTR report relevant to the panel’s expertise. 6. To specify the data reporting procedure. 7. To facilitate access to source documents for Transplant Registry Unit (TRU) staff to do data verification. List of Expert Panel members for each respective discipline: Discipline: Blood and Marrow Transplant Co-chairperson (Adult) Co-chairperson (Paeds) Members

Dr Alan Teh Kee Hean Prof Dr Chan Lee Lee Prof Gan Gin Gin @ Gan Shiaw Sze Dr Hishamshah Mohd Ibrahim Prof Madya Dr S Fadilah Abdul Wahid Dr Ong Tee Chuan

Discipline: Cornea Transplant Chairperson Members

Dr Shamala Retnasabapathy Prof Dato’ Dr Veera Ramani Dr Choong Yean Yaw Dr Michael Law Sie Haur Dr Thiageswari Umapathy Dr Chandramalar Santhirathelagan Associate Prof Dr Mohtar Ibrahim

Discipline: Heart and Lung Transplant Chairperson Members

Mr Mohamed Ezani Hj Md. Taib Dato’ Dr David Chew Soon Ping Dr Aizai Azan Abdul Rahim Dr Abdul Rais Sanusi Dr Ashari Yunus

Discipline: Liver Transplant Chairperson Members

Dr Ganesalingam A/L Kanagasabai Dr Lim Kin Foong Dr Haniza Omar Dr Lim Chooi Bee Prof Dr Lee Way Seah

Discipline: Renal Transplant Chairperson Members

Dr Goh Bak Leong Dato’ Dr Zaki Morad Mohd Zaher Dato’ Dr (Mr) Rohan Malek Dr Fan Kin Sing Dr S Prasad Menon Dr Lily Mushahar Dr Lim Soo Kun

Discipline: Bone and Tissue Transplant Chairperson Members

Dr Suzina Sheikh Ab Hamid Dr Abdul Malik Mohamed Hussein Assoc Prof Dr Ahmad Hafiz Zulkifly Dr Thiageswari Umapathy Dr Ewe Teong Wan Dr Norimah Yusof Assoc Prof Dr Vivek Ajit Singh

Discipline: Cadaveric Organ and Tissue Donations Chairperson Members

Datin Dr Fadhilah Zowyah Lela Yasmin Mansor Dr Hooi Lai Seong Dr Omar Sulaiman Dr Muhammed Anis Bin Abdul Wahab Matron Jamaliah Kario Staff Nurse Santi A/P Krishanan

CONTENTS Foreword

Acknowledgements

Participating Centres

iii

About the National Transplant Registry

vii

NTR Sponsors

vii

Governance Board

viii

Expert Panel

Contents

Report Summary

Chapter 1: Blood and Marrow Transplantation

Chapter 2: Corneal Transplantation

Chapter 3: Heart and Lung Transplantation

Chapter 4: Liver Transplantation

Chapter 5: Renal Transplantation

Chapter 6: Heart Valve Transplantation

125

Chapter 7: Bone and Tissue Transplantation

136

Chapter 8: Cadaveric Organ and Tissue Donation

151

Appendix A: Data Management

180

Appendix B: Analysis Sets and Statistical Methods

184

Appendix C: Glossary

185

Appendix D: Directory of Participating Centres

188

REPORT SUMMARY 1. BLOOD AND MARROW TRANSPLANTATION There were 181 new transplantations done in Malaysia in 2008 with 12 transplant centres. The majority of all transplants were for malignant disorders and most of these are haematological malignancies like leukaemia and lymphoma. The main non-malignant disorders transplanted were thalassaemia and aplastic anaemia. Mean age of new transplant patients in 2008 was 28 + 17 years; 55% were male, 42% Malay, 39% Chinese, 7% Indian and 12% others. Autologous transplants accounted for 36%. Eighty-four percent of the transplant source was from peripheral blood stem cells and 89% were from Human Leukocyte Antigen (HLA) identical donors. In 2008 71 of transplant recipients died. Underlying disease and infection were the commonest causes of death accounting for 51% and 20% respectively. 2. CORNEAL TRANSPLANTATION There were 46 centres which provided cornea transplantation data. Two hundred and thirty new cornea transplantations were reported in Malaysia in 2008. Mean age of new transplant recipients in 2008 was 46 + 20 years. Of these, 62% were male. Thirty-four percent of recipients were Malay, 36% were Chinese, 18% were Indian and 12% were other races. The primary diagnoses for cornea transplantation recipients in 2008 were pseudophakic bullous keratopathy (20%), keratoconus (16%), corneal scar (13%), microbial keratitis (8%) and corneal perforation (8%). Forty-six percent of recipients were legally blind before their transplant surgery. In 2008, 65% of donated corneas were from the USA, 16% from Sri Lanka and 18% from local sources. The mean age of the donors was 56 + 17 years. The commonest cornea transplantation surgery performed was penetrating keratoplasty (82%) i.e. transplantation of a full thickness cornea tissue. Graft survival at 1 year was 77%, 63% at 3 years. 3. HEART AND LUNG TRANSPLANTATION There were a total of 18 patients with heart transplantations reported to the Registry between 1997 and 2008; none were done in 2008. Eight grafts were functioning at the end of 2008 and all were followed up in Institut Jantung Negara.

The transplant patient survival rate was 63% and 44% at 1 year and 3 years respectively. There were no lung transplants in 2008. At the end of the year there were 2 patients with lung transplants surviving with functioning graft and they were followed up at Institut Perubatan Respiratori (IPR). 4. LIVER TRANSPLANTATION There were a total of 100 liver transplantations reported to the Registry between 1993 and 2008; 57 grafts were functioning by the end of 2008. There were 5 new liver transplantations done in Malaysia in 2008. There were 5 follow-up centres for liver transplant recipients in 2008. Mean age of all transplant patients was 9 + 14 years (range 3 months to 74 years); 53% were male, 51% Chinese, 39% Malay, 8% Indian, 72% were for biliary atresia. Majority were living donor liver transplantations (75%). At the time of transplantation the main immunosuppressive drugs used were tacrolimus (77%) and steroids (63%). Transplant patient survival rate for the cohort 1993 to 1998 was 71% at 1 year; survival rate for the cohort 1999 to 2008 was 69% at 1 year. 5. RENAL TRANSPLANTATION There were 57 follow-up centres for renal transplant recipients in 2008. There were 88 new renal transplants in 2008, 3 per million population per year. The number of functioning renal transplants in 2008 was 1730. The transplant prevalence rate was 62 per million population. In 2008, the mean age for new transplant recipients was 34+15 years, 58% were male, 15% had diabetes, 4% were anti-HCV positive at the time of transplantation. Ninety-seven percent of prevalent renal transplant recipients were on prednisolone, 69% on cyclosporine, 24% on tacrolimus, 53% mycophenolate mofetil and 28% on azathioprine. In 2008, 48 (3%) of prevalent transplant recipients died and 32 (2%) lost their grafts. Infection, died at home and cancer were the commonest causes of death accounting for 26%, 23% and 19% respectively. Cardiovascular disease was the fourth commonest cause at 13%. Renal allograft rejection accounted for 72% of graft loss. The overall transplant patient survival rate from 1995 to 2008 was 95%, 91%, 88% and 81% at 1 year, 3 years, 5 years and 10 years respectively, while the overall graft survival rate for these years was 91%, 85%, 80% and 66% respectively. 2

6. HEART VALVE TRANSPLANTATION There were a total of 200 heart valve homografts reported to the Registry between 1996 and 2008; 168 grafts were functioning at the end of 2008. Ninety-three were aortic and 107 were pulmonary valves. Mean age of all heart valve transplant patients was 11 + 10 years (range 1 month to 70 years); 50% were male, 62% Malay. 7. BONE AND TISSUE TRANSPLANTATION In 2008, 108 bone allografts, 9 frozen tendons, 36 frozen skin and 2081 amniotic membranes were supplied by Tissue Bank, USM. Fourteen hospitals used the bone grafts and 13 centres used the amniotic membranes. Characteristics were reported for only 21 of the recipients. 8. CADAVERIC ORGAN AND TISSUE DONATION There were 26 donors in 2008 of which 13 were brain dead multi-organ and tissue donors and 13 were post cardiac death tissue donors. The donation rate was 0.94 donations per million population. The mean age of the donors was 30.8 + 19.1 years, age range 2 â&#x20AC;&#x201C; 71 years of age. Sixty-nine percent were male, 65% were Chinese, 23% Indian, 12% others. Two donors carried the donor pledge card. Ten of the donors died from accidents, 15 died from medical causes. Fifty-eight percent of donations took place in MOH hospitals, 23% in private hospitals and 12% from University hospitals.

CHAPTER 1 BLOOD AND MARROW TRANSPLANTATION Editors: Dr Alan Teh Kee Hean Prof Dr Chan Lee Lee Expert Panel Dr Alan Teh Kee Hean (co-chairperson) Prof Dr Chan Lee Lee (co-chairperson) Dr Gan Gin Gin Dr Hishamshah Mohd Ibrahim Prof Dr S. Fadilah Abdul Wahid Dr Ong Tee Chuan Contents 1.0 Introduction 1.1 Stock and Flow of Blood and Marrow Transplantation x Stock and Flow x Transplant Rates x Places of Transplant 1.2 Recipientsâ&#x20AC;&#x2122; Characteristics x Demographics x Primary Diagnosis

1.3 Transplant Practices x Graft Number x Type of Transplant Source of Transplantation and HLA Match 1.4 Transplant Outcomes x Patient Survival 1.5 Disease-free Survival

BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION BLOOD

FifthReport Report Fifth Report ofof thethe Fifth of the National Transplant Registry 2008 National Transplant Registry 2008 National Transplant Registry 2008

1.0 INTRODUCTION List of Tables Table 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 .........7 Haematopoietic Cell Transplantation activity in Malaysia continued to Table 1.1.2: NewStem Transplant Rate per million(HSCT) population (pmp), 1987-2008 ..............9 increase at a steady pace which was reflected in the increased number of transplants Table 1.1.3: Distribution of Patients by Transplant Centre, 1987-2008......................10 performed on year. of This 5th annual report attempts to provide an accurate record Table 1.2.1:year Distribution Patients by Gender, 1987-2008.......................................13 of the total number of HSCT performed in 2008. Overall access.............................15 to HSCT remained Table 1.2.2: Distribution of Patients by Ethnic Group, 1987-2008 low at 6 per million population. Table 1.2.3: Distribution of Patients by Age Group, 1987-2008.................................17 Table 1.2.4: Distribution of Patients by Primary Diagnosis, 1987-2008.....................19 1.1 STOCK AND FLOW Table 1.3.1: Distribution of Patients by Graft Number, 1987-2008 ............................21 Table 1.3.2: Distribution of Patients by Transplantation Type, 1987-2008 ................23 In 2008 a total HSCT by were performed. Two new centres namely Hospital Table 1.3.3: Typeofof 181 Transplant Centre, 1987-2008...............................................25 Pulau1.3.4: Pinang and ofHospital Universiti Sains Malaysia started autologous HSCT Table Source Stem Cells, 1987-2008 ............................................................26 making a total of 12 transplant centres operating in 1987-2008 Malaysia. ...............................28 The Adult Transplant Table 1.3.5: Distribution of Patients by HLA Match, team 1.3.6: whichDistribution operated inofHospital Kuala LumpurDonor shifted to Hospital1987-2008.29 Ampang in Table Patients by Allogeneic Relationship, December 2006, has performed the most number of HSCT in 2008 contributing 31% Table 1.4.1: Distribution of Patients by Cause of Death, 1987-2008 ..........................30 of the total national transplant activity. List of Figures Table 1.1.1: Figure 1.1.1:Stock Stockand andFlow Flowof ofBlood Bloodand andMarrow MarrowTransplantation, Transplantation,1987-2008 1987-2008........8 Year 1987 1988 1989 1990 1991 1992 1993 1994 1995 1997 Figure 1.1.2: New Transplant Rate per million population (pmp), 1987-20081996 .............9 New transplant Figure 1.1.3: Distribution by 8 6 of Patients 22 5 Centre, 12 1987-2008.......................................12 21 19 25 30 28 33 patients Figure of Patients by Gender, 1987-2008......................................14 Deaths 1.2.1: Distribution 1 1 6 6 1 2 9 5 17 11 15 Figure 1.2.2: Distribution of Patients by Ethnic Group, 1987-2008............................16 Lost to follow0 0 of Patients 0 0 Age0Group, 0 1987-2008 0 0...............................18 0 0 0 Figure 1.2.3: Distribution by up Figure Distribution of Patients by Graft Number, 1987-2008...........................22 Alive at 1.3.1: 31st 7 12 28 27 38 57 67 87 100 117 135 December Figure 1.3.2: Distribution of Patients by Transplantation Type, 1987-2008 ...............24 Figure 1.3.3: Type of Transplant by Centre, 1987-2008 .............................................25 Year 1.3.4: Source 1998 of1999 2001 2002 2003 2004 2005 2006 2007 2008 Figure Stem 2000 Cells, 1987-2008...........................................................27 New transplant Figure 1.4.1: Patient by Year 49 Survival 62 94 108of Transplant, 114 128 1987-2008...............................32 140 148 136 149 181 patients Figure 1.4.2: Patient Survival by Gender, 1987-2008 .................................................32 Deaths 17 16 31 47 34 56 52 61 42 50 71 Figure 1.4.3: Patient Survival by Age Group, 1987-2008 ...........................................33 Lost to follow0 Survival 0 0 Type0 of Transplant, 0 0 1987-2008 0 0 ..............................33 0 0 0 Figure 1.4.4: Patient by up st Alive at 1.5.1: 31 Figure Disease-free Survival for Acute Myeloid Leukaemia, 1987-2008 167 213 276 337 417 489 577 664 758 857 967 December (Allogeneic vs. Autologous)..................................................................34 Figure 1.5.2: Disease-free Survival for Acute Lymphoblastic Leukaemia, 1987-2008 (Allogeneic)...........................................................................................35 Figure 1.5.3: Disease-free Survival for Thalassaemia, 1987-2008 (Allogeneic) ........35 Figure 1.5.4: Disease-free Survival for Non-Hodgkin’s Lymphoma, 1987-2008 (Allogeneic vs. Autologous)..................................................................36 Figure 1.5.5 Disease-free Survival for Hodgkin’s Disease, 1987-2008 (Autologous) 36 Figure 1.5.6: Disease-free Survival for Chronic Myeloid Leukaemia, 1987-2008 (Allogeneic)...........................................................................................37 Figure 1.5.7: Disease-free Survival for Aplastic Anaemia, 1987-2008 (Allogeneic) .37 Figure 1.5.8: Disease-free Survival by Age Group for Acute Myeloid Leukaemia, ...38 Figure 1.5.9: Disease-free Survival by Age Group for Acute Lymphoblastic Leukaemia, 1987-2008 ..........................................................................38 Figure 1.5.10: Disease-free Survival by Age Group for Thalassaemia, 1987-2008....39 Figure 1.5.11: Disease-free Survival by Age Group for Non-Hodgkin’s Lymphoma, 1987-2008..............................................................................................39 57

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Number of patients (n)

Figure 1.1.1: 1.5.12:Stock Disease-free Survival byand AgeMarrow Group for Hodgkinâ&#x20AC;&#x2122;s Disease, 1987-2008 and Flow of Blood Transplantation, 1987-2008 ...............................................................................................................40 Figure 1.5.13: Disease-free Survival by Age Group for Chronic Myeloid Leukaemia, New patients Alive at 31st Dec 1987-2008..............................................................................................40 Figure 1.5.14: Disease-free Survival by Age Group for Aplastic Anaemia, 1987-2008 1,000 ...............................................................................................................41 800 600 400 200 0

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year

FifthReport Report Fifth of the Fifth Report ofof thethe National Transplant Registry 2008 National Transplant Registry 2008 National Transplant Registry 2008

BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.0 1.0 INTRODUCTION INTRODUCTION Haematopoietic Stem Stem Cell Cell Transplantation Transplantation (HSCT) (HSCT) activity activity in in Malaysia Malaysia continued continued to to Haematopoietic increase at a steady pace which was reflected in the increased number of transplants increase at a steady pace whichthwas reflected in the increased number of transplants performed year year on on year. year. This This 55th annual annual report report attempts attempts to to provide provide an an accurate accurate record record performed of the total number of HSCT performed in 2008. Overall access to HSCT remained of the total number of HSCT performed in 2008. Overall access to HSCT remained low low at at 6 6 per per million million population. population. 1.1 1.1 STOCK STOCK AND AND FLOW FLOW In In 2008 2008 aa total total of of 181 181 HSCT HSCT were were performed. performed. Two Two new new centres centres namely namely Hospital Hospital Pulau Pinang Pinang and and Hospital Hospital Universiti Universiti Sains Sains Malaysia Malaysia started started autologous autologous HSCT HSCT Pulau making a total of 12 transplant centres operating in Malaysia. The Adult Transplant making a total of 12 transplant centres operating in Malaysia. The Adult Transplant team which which operated operated in in Hospital Hospital Kuala Kuala Lumpur Lumpur shifted shifted to to Hospital Hospital Ampang Ampang in in team December 2006, has performed the most number of HSCT in 2008 contributing 31% December 2006, has performed the most number of HSCT in 2008 contributing 31% of the the total total national national transplant transplant activity. activity. of Table Table 1.1.1: 1.1.1: Stock Stock and and Flow Flow of of Blood Blood and and Marrow Marrow Transplantation, Transplantation, 1987-2008 1987-2008 Year Year New transplant transplant New patients patients Deaths Deaths Lost to to followfollowLost up up Alive at at 31 31stst Alive December December

1987 1987

1988 1988

1989 1989

1990 1990

1991 1991

1992 1992

1993 1993

1994 1994

1995 1995

1996 1996

1997 1997

22 22

12 12

21 21

19 19

25 25

30 30

28 28

33 33

17 17

11 11

15 15

12 12

28 28

27 27

38 38

57 57

67 67

87 87

100 100

117 117

135 135

Year Year New transplant transplant New patients patients Deaths Deaths Lost to to followfollowLost up up Alive at at 31 31stst Alive December December

1998 1998

1999 1999

2000 2000

2001 2001

2002 2002

2003 2003

2004 2004

2005 2005

2006 2006

2007 2007

2008 2008

49 49

62 62

94 94

108 108

114 114

128 128

140 140

148 148

136 136

149 149

181 181

17 17

16 16

31 31

47 47

34 34

56 56

52 52

61 61

42 42

50 50

71 71

167 167

213 213

276 276

337 337

417 417

489 489

577 577

664 664

758 758

857 857

967 967

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 New patients

Alive at 31st Dec

Number Number of of patients patients (n) (n)

1,000 800 600 400 200 0

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year

FifthReport Report Fifth of the Fifth Report ofof thethe National Transplant Registry 2008 National Transplant Registry 2008 National Transplant Registry 2008

BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.0 INTRODUCTION Table 1.1.2: New Transplant Rate per million population (pmp), 1987-2008 Year

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Haematopoietic Stem Cell Transplantation (HSCT) activity in Malaysia continued to increase at a steady pace which was reflected in the increased number of transplants New transplant 8 6 22 5 12 21 19 25 30 28 33 patients performed year on year. This 5th annual report attempts to provide an accurate record New transplant of the total number1 of HSCT performed remained 0 1 0 in 2008. 1 1Overall 1 access 1 to HSCT 1 1 2 rate, pmp low at 6 per million population.

1.1 STOCK AND1998 FLOW Year 1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

New transplant 62 94 114 128 new 140 centres 148 namely 136 149 181 In 2008 a total of49181 HSCT were 108 performed. Two Hospital patients Pulau Pinang and Hospital Universiti Sains Malaysia started autologous HSCT New transplant 2 3 4 5 5 5 5 6 5 5 7 making rate, pmp a total of 12 transplant centres operating in Malaysia. The Adult Transplant

team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in December 2006, has performed the most number of HSCT in 2008 contributing 31% of the total transplantRate activity. Figure 1.1.2:national New Transplant per million population (pmp), 1987-2008 Table 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 7 1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

100

117

135

Year New transplant 3 patients Deaths Lost to follow2 up Alive at 31st December1

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

New Tranplant rate pmp

Year New transplant patients 6 Deaths Lost to follow5 up Alive at 31st December 4

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Table 1.1.3: of Patients by and Transplant 1987-20081987-2008 Figure 1.1.1:Distribution Stock and Flow of Blood MarrowCentre, Transplantation, 1987 No. % KLA 0 0 KLP 0 0 UKM 1,0000 0 SJA 0 0 UMA 0 0 UMP 8008 100 GMC 0 0 LWE 0 0 SJP 0 0 6000 HUSM 0 ASH 0 0 HA 0 0 HPP 4000 0 Others 0 0 TOTAL 8 100

Number of patients (n)

Year

1988 No. % 0 0 0 0 0 0 0 0 0 0 6 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 100

1989 1990 No. % No. % New 0 patients 0 0 0 0 0 0 0 0 0 0 0 1 5 0 0 0 0 0 0 21 95 5 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22 100 5 100

1991 1992 No. % No. % 0 Alive 0 at 31st 0 Dec 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 100 21 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 100 21 100

1993 No. % 0 0 0 0 0 0 0 0 1 5 18 95 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19 100

200

1994 1995 1996 1997 1998 1999 2000 No. % No. % No. % No. % No. % No. % No. % KLA 0 0 0 0 0 0 0 0 0 0 6 10 15 16 04 KLP 16 10 33 10 36 9 27 16 33 19 31 16 17 UKM 0 870 88 89 0 90 91 0 92 93 0 94 095 96097 98099 000 01 02 0 03 04 2 05 06 3 07 908 10 Year SJA 0 0 0 0 0 0 0 0 0 0 5 8 19 20 UMA 4 16 7 23 6 21 9 27 15 30 11 18 13 14 UMP 17 68 13 43 11 39 15 46 18 37 19 31 22 23 GMC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LWE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SJP 0 0 0 0 1 4 0 0 0 0 0 0 0 0 HUSM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ASH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 HA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 HPP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Others 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL 25 100 30 100 28 100 33 100 49 100 62 100 94 100 Year KLA KLP UKM SJA UMA UMP GMC LWE SJP HUSM ASH HA HPP Others TOTAL

2001 No. % 20 19 18 17 12 11 17 16 19 18 22 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 108 100

2002 No. % 28 25 20 18 9 8 20 18 16 14 20 18 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 114 100

2003 No. % 36 28 19 15 11 9 23 18 10 8 20 16 0 0 0 0 9 7 0 0 0 0 0 0 0 0 0 0 128 100

2004 No. % 42 30 22 16 14 10 21 15 10 7 16 11 2 1 6 4 6 4 0 0 0 0 0 0 0 0 1 1 140 100

10 8

2005 No. % 45 30 21 14 17 11 23 16 14 9 13 9 2 1 1 1 12 8 0 0 0 0 0 0 0 0 0 0 148 100

2006 No. % 31 23 26 19 9 7 22 16 9 7 18 13 4 3 2 1 6 4 0 0 1 1 8 6 0 0 0 0 136 100

2007 No. % 0 0 26 17 21 14 21 14 12 8 16 11 2 1 1 1 5 3 0 0 1 1 44 30 0 0 0 0 149 100

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BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.0 Year

INTRODUCTION 2008 No.

Total No.

0 KLA Haematopoietic

0 Cell 223Transplantation 15 Stem (HSCT) activity in Malaysia continued to 29 16 265 KLP increase at a steady pace which 17 was reflected in the increased number of transplants 24 on13year. 128 UKM performed year This 5th8annual report attempts to provide an accurate record 14 197 13 SJA of the total25 number of HSCT performed in 2008. Overall access to HSCT remained 17 9 173 11 UMA low at 6 per million population. 16 9 347 23 UMP 1 1 11 1 GMC 1.1 STOCK0 AND0FLOW 10 1 LWE 4 2 44 3 SJP In 2008 a total of3 181 HSCT were performed. Two new centres namely Hospital 6 6 0 HUSM 0 0 2 0 ASH Pulau Pinang and Hospital Universiti Sains Malaysia started autologous HSCT 57 of 31 109 7 HA making a total 12 transplant centres operating in Malaysia. The Adult Transplant 2 1 2 0 HPP team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in 0 0 performed 1 0 most number of HSCT in 2008 contributing 31% Others December 2006, has the 181 100 1518 100 TOTAL of the total national transplant activity. *Others include Royal Perth Australia Hospital

Table andKuala Flow of Blood KLA 1.1.1: Stock Hospital Lumpur, (Adult)and Marrow Transplantation, 1987-2008 KLP Year UKM New transplant SJA patients UMA Deaths UMP Lost to followGMC up LWE Alive at 31st SJP

Hospital 1987 Kuala 1988Lumpur, 1989 Institute 1990Paediatrics 1991 (Paed) 1992 Pusat Perubatan Universiti Kebangsaan Malaysia 6 22 5 12 (Adult) 21 Sime8 Darby Medical Centre, Subang Jaya University of Malaya Medical Centre (Adult) 1 1 6 6 1 2 University of Malaya Medical Centre (Paed) Gleneagles Medical Centre, Penang 0 0 0 0 0 0 Lam Wah Ee Hospital, Penang Sime7 Darby 12 Medical28 Centre, Subang Jaya 27 38 (Paed) 57 December Hospital Universiti Sains Malaysia HUSM ASH Ampang Puteri Specialist Hospital HA Hospital Year 1998 Ampang 1999 2000 2001 2002 2003 HPP New transplant Hospital Pulau Pinang

patients Deaths Lost to followup Alive at 31st December

1993

1994

1995

1996

1997

100

117

135

2004

2005

2006

2007

2008

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

7 11

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BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: 1.1.3: Stock Distribution of Patients Centre, 1987-2008 and Flow of Bloodbyand Marrow Transplantation, 1987-2008 KLA

KLP

UKM New patients

SJA

UMA Alive at 31st Dec

UMP

140 1,000

Number Number of of patients patients (n) (n)

120

800

100

600 80 60

400

200

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year Year

GMC

LWE

SJP

HUSM

ASH

HPP

Others

100

Number of patients (n)

90 80 70 60 50 40 30 20 10 0

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08

Year

12 8

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BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.0RECIPIENTSâ&#x20AC;&#x2122; INTRODUCTION 1.2 CHARACTERISTICS Haematopoietic Stem Cell (HSCT) activity in ethnic Malaysia continuedwas to Out of the 181 HSCT, the Transplantation male:female ratio was 55:45. The breakdown increase at a steady pace which was reflected in the increased number of transplants 42%, 39%, 7%, 11% and 1% forth Malay, Chinese, Indian, Bumiputra East Malaysians performed year on year. Patients This 5 aged annual report attempts to provide an37% accurate record and Others respectively. younger than 20 years formed of patients of the total number of HSCT performed in 2008. Overall access to HSCT remained transplanted while those aged greater than 60 years was only 2%. The commonest low at 6 performillion indications HSCTpopulation. were acute leukaemia, lymphoma and hypoplastic anaemia. 1.1 STOCK AND FLOW Table 1.2.1: Distribution of Patients by Gender, 1987-2008 Year

1987

1988

1989

1990

1991

1992

1993

1994

Year

1995

1996

1997

1998

1999

2000

2001

2002

In 2008No.a total performed. namely Gender % of No.181% HSCT No. were % No. % No. Two % new No. centres % No. % Hospital No. % Pulau Pinang and Hospital Universiti Sains Malaysia started autologous HSCT Male 7 88 4 67 12 55 3 60 7 58 13 62 13 68 16 64 making a1 total of 12 transplant centres operating in Malaysia. The 6Adult32Transplant Female 13 2 33 10 45 2 40 5 42 8 38 9 36 team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in TOTAL 8 100 6 100 22 100 5 100 12 100 21 100 19 100 25 100 December 2006, has performed the most number of HSCT in 2008 contributing 31% of the total national transplant activity. Gender

No.

Male

1996

54 1997

100

108

100

Table 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Year 1987 1988 Female 19 63 13 46 New transplant 8 6 TOTAL patients 30 100 28 100 Deaths 1 1 Lost to followYear 2003 0 2004 0 up Gender No. % No. % Alive at 31st 784 12 Male 71 55 60 December Female

Year TOTAL

128

100

New transplant patients Deaths Lost to followup Alive at 31st December

1998 140 1999 100

1989 22

100

1990

1991

2005 0

No.

7128 48

16 49

2006

No.

2780 56

2000100 2001 148 136

1992 21

1993

1994

1995

100

40 94

100

2007 0

2008 0

38 59 41

2002 100

No.

9057 60

No.

6799 82

20031002004 149 181

87 55 45

2005 100

114

100

0Total

No.

653

100 865

57117

2006 1002007 1518

135 2008

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

7 13

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: 1.2.1: Stock Distribution of Patients Gender, 1987-2008 and Flow of Bloodbyand Marrow Transplantation, 1987-2008 Male New patients

Female Alive at 31st Dec

100 1,000

Percentage patients(n) (%) Number ofofpatients

90 80 800 70 60 600 50 40 400 30 20 200 10

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year Year

14 8

FifthReport Report Fifth of the Fifth Report ofof thethe National Transplant Registry 2008 National Transplant Registry 2008 National Transplant Registry 2008

BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.0 INTRODUCTION Table 1.2.2: Distribution of Patients by Ethnic Group, 1987-2008 Year

1987

1988

Haematopoietic Race No. %

1989

1990

1991

1992

1993

1994

Stem (HSCT) activity Malaysia continued to No. Cell % Transplantation No. % No. % No. % No. in % No. % No. % increase at was increased number Malay 2 a steady 25 4 pace 67 which 13 59 reflected 2 40 in4 the 33 4 19 3 of16transplants 9 36 th Chinese 63 on 2year.33 This 8 5 36 3 report 60 7 58 to10provide 48 10 accurate 53 12 48 performed5 year annual attempts an record Indian 1 number 13 0 of HSCT 0 0 performed 0 0 in 02008. 1 Overall 8 4 access 19 to 1HSCT 5 remained 0 0 of the total Bumiputra low at 6 per million population. 0 0 0 0 1 5 0 0 0 0 2 10 3 16 4 16 Sabah

Bumiputra 1.1 STOCK 0 Sarawak

AND 0 0FLOW 0

Others

Indian

Sabah Year

1 1989

19900

0 1991

1992

19933

022

12 0

0 21

330

100

100 0

In 2008 a total of 181 HSCT were performed. Two new centres namely Hospital TOTAL 8 100 6 100 22 100 5 100 12 100 21 100 19 100 25 100 Pulau Pinang and Hospital Universiti Sains Malaysia started autologous HSCT making a total of 121996 transplant1997 centres operating in Malaysia. The Adult Transplant Year 1995 1998 1999 2000 2001 2002 team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in Race No. % No. % No. % No. % No. % No. % No. % No. % December 2006, has performed the most number of HSCT in 2008 contributing 31% Malay 7 23 8 29 9 27 20 41 31 50 33 35 47 44 37 32 of the total Chinese 14 national 47 11transplant 39 20 activity. 61 24 49 26 42 48 51 48 44 65 57 Table Bumiputra1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 New transplant Bumiputra 0 Sarawak patients

0 19870 1988

611

Deaths Others

10 5 17 1 0 Lost to followTOTAL 30 100 0 28 100 0 up Alive at 31st 2003 Year 7 200412 December

2005 28

Race

No.

Malay

Year 65 New transplant Indian 6 patients Bumiputra Deaths 4 Sabah Lost to followBumiputra up 4 Sarawak Alive at 31st Others December 3

1998

2000

1999

62 6

1494

49 9

17 9

16 6

531

TOTAL

100

Chinese

128

3 2

1671 140

62 0 100

200638

2007 57

No.

2001

2002

114 8

10811

47 7

34 5

6 56

213 1

100

148

100

337 5 136

2003

250

130

331

317

152

0 94

100 0 200887

108 0

2004

2005

2006

14012

148 7

136 117

5214

61 8

417 4

100

149

100

5772 181

1 1996 1 1997

100 0 114

Total 117 100 No.

7 15

19 0

489

No.

18128 12

1 1995

No.

276

3 1994

135

580

690

42 62

0100

2007

2008

8 149

181

857

967

664 1

758

100

1518

100

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Figure 1.2.2: Distribution of Patients by Ethnic Group, 1987-2008 Malay

1,000

New patients

Bumiputera Sabah

Chinese

Alive at 31st Dec

Bumiputera Sarawak

Indian Others

Percentage of patients (%)(n) Number of patients

100

800 90 80 70 600 60 50 400 40 30

200 20 10

0 0

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year Year

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08

16 8

FifthReport Report Fifth of the Fifth Report ofof thethe National Transplant Registry 2008 National Transplant Registry 2008 National Transplant Registry 2008

BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.0 INTRODUCTION Table 1.2.3: Distribution of Patients by Age Group, 1987-2008 Year 1987 1988 1989 1990 1991 1992 1993 1994 Age Haematopoietic Stem Cell Transplantation (HSCT) activity in Malaysia continued No. % No. % No. % No. % No. % No. % No. % No. %to group increase at a steady pace which was reflected in the increased number of transplants 0-9 4 50 4 67 17 th 77 5 100 10 83 15 71 9 47 11 44

performed4 year on 2year.33 This5 5 23annual report attempts to6 provide an accurate record 50 0 0 2 17 29 10 53 11 44 of the total number of HSCT performed in 2008. Overall access to HSCT remained 20-39 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 12 low at 6 per million population. 40-59 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10-19

1.1 STOCK AND TOTAL 8 100 6FLOW 100 22 Mean

In SD

100

2008 a total of 181 Two new 4centres namely Hospital 4 3 HSCT3 were performed. 3 4 5 7 Pulau Pinang and Hospital Universiti started autologous HSCT Median 9 7.5 8 6 Sains Malaysia 6 6 10 11 making a total of 12 2transplant1 centres operating in The Adult Transplant Minimum 2 2 1 Malaysia. 1 1 1 team which15 operated10 in Hospital Kuala Maximum 13 9 Lumpur 13 shifted14to Hospital 17 Ampang 29 in December 2006, has performed the most number of HSCT in 2008 contributing 31% Year 1996 1997 1999 2000 2001 2002 of the total1995 national transplant activity. 1998 Age group Table 0-9

No.

1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 12 40 13 46 19 58 21 43 28 45 27 29 23 21 30

Year 1987 1988 10-19 13 43 12 43 New transplant 20-39 4 13 8 3 11 6 patients 40-59 1 3 0 0 Deaths 1 1 60 0 0 0 0 Lost to follow0 28 100 0 TOTAL 30 100 up Mean 11 Alive at 31st 13 7 12 SD 9 9 December Median

Year Minimum

1989 1990 8 24 16 522 15 1 0

330

100

New transplant41 Max 37 49 62 patients Deaths 17 200416 Year 2003 Lost to followAge 0 No. % 0 No. %. group up st 0-9 33 26 19 Alive at 31 42 167 213 December 10-19 18 14 41 29

0 100 13 10

11999

12 21 20

0 0

0 49

199224 1993 15 27

24 12

1998

5 12

1991 33

140

56 2007

2006 34

0No. 40

337

0 %

No. 0 %

417

489

148

2008 61

0No. 25

577

100 16

0 100 23

135

136

149

42 Total

857

967

No. 0

448

368

758

419

259

100

140

100

148

100

136

100

149

100

181

100

1518

Mean

100

22.5

23.5

Minimum

5 months

1 month

Maximum

7 17

0114

21.5

Median

2007

40-59

128

12006 month

20-39

TOTAL

32 33

117

664

108 0 100

1997 22

2836

1 2005 61

114

40 30 37 16

20 25

0 100 23

128

1995 26 1996 28 25

094

31 2005

276

2004

108

1 2003

1919

5 months 2001 2002

94 No.0

0 100

1 2000

1994 29

12008 55

181

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Figure 1.2.3: Distribution of Patients by Age Group, 1987-2008 New patients

1,000

0-9 years

10-19 years

40-59 years

Â&#x2022;60 years

Alive at 31st Dec

20-39 years

Percentage of patients (%)(n) Number of patients

100

800 90 80 70 600 60 50 400 40 30

200 20 10

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year Year

18 8

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BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION BLOOD

1.0 INTRODUCTION Table 1.2.4: Distribution of Patients by Primary Diagnosis, 1987-2008

Year

1987

1988

1989

1990

1991

1993

1992

1994

Haematopoietic Stem Cell Transplantation (HSCT) activity in Malaysia continued to No. % % No. % No. No. % No. % % No. increase at a steady paceNo. which was reflected in % the increased number ofNo.transplants Acute leukaemia 5 63 4 67th 8 36 2 40 1 8 4 19 6 32 performed year on year. This 5 annual report attempts to provide an accurate record8 Chronic leukaemia 0 0 0 0 1 5 1 20 1 8 4 11 4 of the total number of HSCT performed in 2008. Overall access to 19 HSCT2 remained Hypoplastic low at 6 per million population. 2 25 0 0 4 18 0 0 4 33 5 24 4 21 5 anaemia Diagnosis

Erythrocytic 1.1 STOCK disorders Lymphoma

In 2008 Solid tumors

0 0 0 AND FLOW 0

Lymphoma

Year New transplant Myelodysplasia patients Haemoglobinopathy Deaths Multiple myeloma Lost to followOthers up Alive at 31st TOTAL December Solid tumors

1987

No.

1988

1998 1

049

0 17

10 30

167

Year

No.

618

100

1991

1992

No.

2 14

014

284

027

38 0

57 0

2001 1

20022

2003 4

0108 0

1141

2 128

940

0 0 28

213

2003

100

276

337

2004

6 100

417

2005

1995

No.

1996

1997

No.

5 13

17 14

1811 17

0 11

0 12

0 67

87 0

2004 5

0 10

100

577

2006

6 100

3 94

664

2007

No.

20083

4149 4

1814

2007

100

108

758 2008

857

100

7 4

114

967

Total

No.

Acute leukaemia

558

Chronic leukaemia

167

Hypoplastic anaemia

138

Erythrocytic disorders

Lymphoma

283

Solid tumors

Myelodysplasia

Haemoglobinopathy

144

Multiple myeloma

Others

128

100

140

100

148

100

136

100

149

100

181

100

1518

100

No.

7 19

1351

Diagnosis

TOTAL

0117 0

2002

100 0

1 136

0 100

1481

0140 0

2006 2

20052

1519

489

1994

1993

62 0

1990

19990 2000 0

1989

No.

1.1.1: Stock1995 and Flow1996 of Blood1997 and Marrow 1987-2008 1998 Transplantation, 1999 2000 2001

Year Diagnosis New transplant patients Acute leukaemia Deathsleukaemia Chronic Lost to followHypoplastic up anaemia Alive at 31st Erythrocytic December disorders

a total 0of 181 HSCT Two namely 0 0 0 were 0 performed. 0 0 0 0new0 centres 3 14 1 Hospital 5 1 Pulau Pinang and Hospital Universiti started HSCT Myelodysplasia 0 0 0 0 0 0 Sains 0 Malaysia 0 0 0 0 autologous 0 1 5 2 making a total of 12 transplant centres operating in Malaysia. The Adult Transplant Haemoglobinopathy 1 13 2 33 7 32 1 20 4 33 4 19 2 11 5 team myeloma which operated Ampang in0 Multiple 0 0 in 0 Hospital 0 0 Kuala 0 Lumpur 0 0 shifted 0 0 to Hospital 0 0 0 0 December 2006,0 has 0performed contributing Others 0 0 the1most5 number 0 0of HSCT 1 8in 2008 0 0 3 16 31% 0 of the total national transplant activity. TOTAL 8 100 6 100 22 100 5 100 12 100 21 100 19 100 25 Table Year

3 100

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Number of patients (n)

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Diagnosis Categorisation 1 Acute leukaemia, unclassified New patients Alive at 31st Dec 2 Acute undifferentiated leukaemia 3 Acute Lymphocytic Leukaemia (ALL) 1,000 Acute leukaemia 4 Acute Myelogenous Leukaemia (AML) denovo 5 AML post-chemotherapy 6 AML post-MDS 800 7 Chronic lymphocytic leukaemia Chronic leukaemia 8 Chronic myeloid leukaemia 9 Aplastic anaemia Hypoplastic anaemia 600 10 Fanconi's anaemia 11 Diamond-Blackfan anaemia Erythrocytic Disorders 12 Congenital Dyserythropoeitic Anaemia (CDA) 400 13 Hodgkin's lymphoma Lymphoma 14 Non-Hodgkin's lymphoma, Aggressive 15 Non-Hodgkin's lymphoma, Indolent 200 breast 16 Carcinoma, 17 Carcinoma, ovary 18 Germ Cell Tumour (GCT)-testicular 0 19 GCT-primary 87 88non-testis 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 20 Ewing's sarcoma Year Solid tumors 21 Glioma 22 Hepatoblastoma 23 Neuroblastoma 24 Rhabdomyosarcoma 25 Soft tissue sarcoma (non-RMS) 26 Wilms tumour 27 Primitive Neuroectodermal Tumour (NET) 28 Juvenile Myelomonocytic leukaemia Myelodysplasia 29 Myelodyplastic syndrome (MDS) 30 Myelofibrosis 31 Thalassaemia major Haemoglobinopathy 32 Sickle Cell Anaemia 33 Multiple myeloma Multiple myeloma 34 Haemophagocytic Lymphohistiocytosis Syndrome 35 Congenital Immunodeficiencies Others 36 Osteopetrosis 37 Others

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1.0TRANSPLANT INTRODUCTION 1.3 PRACTICES Haematopoietic Stem Cell8% Transplantation (HSCT) activity in Malaysia continued to Second grafts constituted of the 181 transplants performed. The majority of the increase at a steady pace which was reflected in the increased number of transplants grafts were allogeneic (64%). The commonest stem cell source was peripheral blood performed year on which year. This 5th annual to provide an and accurate stem cells (PBSC) formed 84% ofreport HSCTattempts done. Bone marrow cord record blood of the total number of HSCT performed in 2008. Overall access to HSCT remained stem cells contributed 11% and 5% to the total, respectively. low at 6 per million population. The donors for the 115 allogeneic HSCT were HLA-identical sibling donors in 102 1.1 STOCK AND13FLOW cases. There were unrelated donors who were 1-antigen mismatched in 7 cases and 2-antigen mismatched in 6 cases. The unrelated donor transplantations used cord In 2008 of 181forHSCT were The performed. new centres namely Hospital blood for a8 total and PBSC 5 patients. recourseTwo to unrelated donors remained low and compared Hospital Universiti Malaysia startedKong autologous HSCT atPulau 11% Pinang in Malaysia with Japan,Sains Singapore and Hong where 40-60% making totalunrelated of 12 transplant of HSCTaused donors. centres operating in Malaysia. The Adult Transplant team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in December has performed the by most number of HSCT in 2008 contributing 31% Table 1.3.1:2006, Distribution of Patients Graft Number, 1987-2008 Year of the total national1988 transplant1989 activity. 1990 1987 1991 1992 1993 1994 Graft number

No.

100

6 1987

No.

19 1989 86

4 1990

No.

18 1995

95199624

Table 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 1Year 2New

0 transplant

3patients

Deaths TOTAL

100

Lost to follow-

up Year

Alive at 31 Graft DecemberNo. number

16 0

1995 st

100 1988

1 100 1996

22 6 100

0 12

22 0

No.

100

1 94

Year 1998 1999 2 1 3 0 0 New transplant 62 3 0 0 490 0 patients TOTAL 30 100 28 100 Deaths 17 16 Lost to follow0 2004 0 Year 2003 up st Graft Alive at 31 No. % 167 No. % 213 number December

2000

91992 75 1993 19

1 100

1997

80 1991

1998

No. 47

0 38

0 100

No.

2001

2002

1081

114 2

0128 0

100

4749

100

0 2005

No. 276 %

No. 337

2003 56

100

0 2007

% 417

No. 489 %

2006

9 21 0

1999

90 1994

No. 91

100

117

No.

103

113

136 0

0 149 0

1400

148 0

5294

100

108

2008 0

No. 577

% 664

2007

100

0 Total No. 758

%857

125

135

125

123

121

156

1395

128

100

138

100

127

100

126

100

123

100

169

100

1447

100

Note: Missing in graft number = 71 patients (5%)

7 21

135

% 99

2008 1

181 0

100 50 114 71

TOTAL

No.

2006

15 100

2002

2005

100 11 25

2001

96 1997

1917

2004 3

5 100 2000

0 967

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Figure 1.3.1: Distribution of Patients by Graft Number, 1987-2008

1,000

New patients Alive at 31st Dec Graft number 1 Graft number 2 Graft number 3

Percentage Numberofofpatients patients(%) (n)

100

800 600 400 200

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year Year

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08

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BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.0 INTRODUCTION Table 1.3.2: Distribution of Patients by Transplantation Type, 1987-2008 Year

1987

1988

1989

1990

1991

1992

1993

1994

Haematopoietic Stem Cell Transplantation (HSCT) activity in Malaysia continued to Type of No. % No. % No. % No. % No. % No. % No. % No. % transplant increase at a steady pace which was reflected in the increased number of transplants th Allogeneic + performed year on year. This provide record 8 100 6 100 5 21 annual 95 5report 100 attempts 12 100 to 20 95 an18accurate 95 24 96 Syngeneic of the total number of0 HSCT performed in 2008. Overall access to HSCT remained 0 0 0 1 5 0 0 0 0 1 5 1 5 1 4 low at 6 per million population. TOTAL 8 100 6 100 22 100 5 100 12 100 21 100 19 100 25 100 Autologous

1.1 STOCK AND FLOW 1995 1996

Year

1997

1998

1999

2000

2001

2002

Type of transplant In 2008

No. % No. % No. % No. % No. % No. % a No. total % of 181 HSCT were performed. Two%newNo.centres namely Hospital Allogeneic Pulau +Pinang and Hospital Universiti Sains Malaysia started autologous HSCT 29 97 26 93 27 82 32 65 44 71 56 60 75 69 75 66 Syngeneic making a total of 12 transplant centres operating in Malaysia. The Adult Transplant Autologous 1 3 2 7 6 18 17 35 18 29 38 40 33 31 39 34 team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in TOTAL 30 100 28 100 33 100 49 100 62 100 94 100 108 100 114 100 December 2006, has performed the most number of HSCT in 2008 contributing 31% of the total national transplant activity. Year

2003

2004

Type of % Table 1.1.1:No. Stock% andNo.Flow transplant

Year Allogeneic + 83 Syngeneic New transplant patients Autologous Deaths TOTAL

45 128

Lost to followup Alive at 31st December

Year New transplant patients Deaths Lost to followup Alive at 31st December

1987

1988

64 36

2005

2006

2007

2008

Total

% and No.Marrow % No. % No. % 1987-2008 No. % ofNo. Blood Transplantation,

1989 91

6148

1990 61

1006

1991

1992

1100

2 149

64 36

1993

115

1996

1997

10011

1019

499

140 1 100

100

117

135

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

7 23

5100

1995

1 100

136

1009 181

1994

17 1518

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Figure 1.3.2: Distribution of Patients by Transplantation Type, 1987-2008 New patients

Allogeneic+Syngeneic

Alive at 31st Dec Autologous

1,000 180

Number patients Number of of patients (n)(n)

160

800 140 120 600 100

400 80 60

200 40 20

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year Year

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BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION BLOOD

1.0 INTRODUCTION Table 1.3.3: Type of Transplant by Centre, 1987-2008

Type of transplant Allogeneic + Syngeneic Autologous TOTAL Centre % No. activity% No. continued % to Haematopoietic Stem CellNo. Transplantation (HSCT) in Malaysia KLA 112 11 22 number 223of transplants 15 increase at a steady pace which was reflected in111 the increased KLP 236 5th annual 23 report attempts 29 6 17 performed year on year. This to provide an265 accurate record UKM 69 7 59 12 128 8 of the total number of HSCT performed in 2008. Overall access to HSCT remained SJA 75 7 122 24 197 13 low at 6 per million population. UMA 119 12 54 11 173 11 UMP 307 30 40 8 347 23 1.1 STOCK AND FLOW 5 GMC 0 6 1 11 1 LWE 9 1 1 0 10 1 SJP 38 4 6Two new 1centres namely 44 3 In 2008 a total of 181 HSCT were performed. Hospital HUSM 0 0 6 1 6 0 Pulau Pinang and Hospital Universiti Sains Malaysia started autologous HSCT ASH 1 0 1 0 2 0 making a total of 12 transplant centres5operating62 in Malaysia. The Adult Transplant HA 47 12 109 7 team which operated in Hospital Kuala Lumpur HPP 0 0 2 shifted 0to Hospital 2 Ampang 0 in December 2006, has performed the most number of HSCT in 2008 contributing Other 1 0 0 0 1 031% of the total national transplant TOTAL 1019 activity.100 499 100 1518 100

Figure 1.3.3:Stock Type and of Transplant by Centre, 1987-2008 Table 1.1.1: Flow of Blood and Marrow Transplantation, 1987-2008 1987

1988

22 5 12 21 Allogeneic+Syngeneic

25 Autologous 30 28

100

117

135

Year 200 New transplant patients Deaths 150 Lost to followup st Alive at 31 100 December

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

Number of patients (n)

Year New transplant patients Deaths 300 Lost to followup Alive at 31st December250

1989

1990

1991

1992

1993

1994

1995

1996

KLA

KLP

UKM

SJA

UMA

UMP

GMC

LWE

Centre

7 25

SJP

HUSM

ASH

HPP

Other

1997

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Table 1.3.4: Source of Stem Cells, 1987-2008

Number of patients (n)

Year Transplant source Marrow1,000 PBSC / Marrow + PBSC Cord blood / 800 Marrow + cord TOTAL

600

Year Transplant source Marrow 400 PBSC / Marrow + PBSC Cord blood / 200 Marrow + cord TOTAL Year

Transplant source Marrow PBSC / Marrow + PBSC Cord blood / Marrow + cord TOTAL

1987

1988

1990

100

100 22 100

1996 No.

1997

No.

100 12 100 21 100

1998

1999

2000

No.

1994

100 22 100

No.

1993

No.

1992

Alive at 31st Dec

No.

1991

No.

1995

1989

New patients

No.

100 25 100

2001

2002

No.

30 100 28 100 24

30 100 28 100 33 100 49 100 62 100 94 100 108 100 114 100 2003

2004

2005

2006

2007

2008

Total

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 No. % No. % No. % No.Year % No. % No. % No. % 44

513

62 101 72 116 78 109 80 119 80 152 84

939

128 100 140 100 148 100 136 100 149 100 181 100 1518 100

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BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.0 INTRODUCTION Figure 1.3.4: Source of Stem Cells, 1987-2008 Haematopoietic Stem Cell Transplantation (HSCT) activity in Cord Malaysia continued to Marrow PBSC/ Marrow+ PBSC blood/ Marrow + cord increase at a steady pace which was reflected in the increased number of transplants performed year on year. This 5th annual report attempts to provide an accurate record 180 of the total number of HSCT performed in 2008. Overall access to HSCT remained low160 at 6 per million population. Number of patients (n)

1.1 140 STOCK AND FLOW 120 In 2008 a total of 181 HSCT were performed. Two new centres namely Hospital Pulau 100Pinang and Hospital Universiti Sains Malaysia started autologous HSCT making a total of 12 transplant centres operating in Malaysia. The Adult Transplant team80which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in December 2006, has performed the most number of HSCT in 2008 contributing 31% of the60total national transplant activity. 40 Table 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Year 20 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 New transplant 8 6 22 5 12 21 19 25 30 patients0 87 88 189 90 191 92 693 94 695 96 97 Deaths 1 98 99 2 00 01 9 02 03 5 04 05 17 06 Year Lost to follow0 0 0 0 0 0 0 0 0 up Alive at 31st 7 12 28 27 38 57 67 87 100 December Year New transplant patients Deaths Lost to followup Alive at 31st December

1997 33

07 11 08 15 0

117

135

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

7 27

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Table 1.3.5: Distribution of Patients by HLA Match, 1987-2008 Year

1987

HLA Match Identical 1 AG

1,000

2 AG 3 AG Disparate

Number of patients (n)

TOTAL

800

8 0 0 0 8

100 0 0 0 100

Year

600 HLA Match Identical 1 AG 2 AG

400

3 AG Disparate TOTAL Year Identical 1 AG

2 AG 3 AG Disparate TOTAL

No.New patients % No.

6 0 0 0 6

1992

100 0 0 0 100

1989

21 0 0 0 21

1993

1990

100 0 0 0 100

Alive No. at 31st % DecNo. 5 0 0 0 5

1994

100 0 0 0 100

1991 %

12 0 0 0 12

1995

100 0 0 0 100 1996

No.

20 0 0 0 20

100 0 0 0 100

18 0 0 0 18

100 0 0 0 100

23 1 0 0 24

96 4 0 0 100

29 0 0 0 29

100 0 0 0 100

26 0 0 0 26

100 0 0 0 100

200

HLA Match

1988

No.

1997

1998

1999

2000

2001

No.

0 27

0 100

0 32

0 100

0 44

0 100

0 56

0 100

1 75

1 100

872 88 89 790 91 92 0 93 94095 96 97 3 98 997 00 01 002 03 04 0 05 06407 08 5 0 0 1 3 1Year 2 4 7 1 1

Year

2002

2003

2004

2005

2006

HLA Match

No.

Identical

70 3 2 0 75

93 4 3 0 100

78 3 2 0 83

94 4 2 0 100

83 3 4 0 90

92 3 4 0 100

86 4 1 0 91

95 4 1 0 100

81 4 2 0 87

93 5 2 0 100

1 AG 2 AG 3 AG Disparate TOTAL Year

2007

2008

Total

HLA Match

No.

Identical

68 4 2 1 75

91 5 3 1 100

102 7 6 0 115

89 6 5 0 100

953 38 26 2 1019

94 4 3 0 100

1 AG 2 AG 3 AG Disparate TOTAL

28 8

BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION BLOOD

FifthReport Report Fifth Report ofof thethe Fifth of the National Transplant Registry 2008 National Transplant Registry 2008 National Transplant Registry 2008

1.0 INTRODUCTION Table 1.3.6: Distribution of Patients by Allogeneic Donor Relationship, 1987-2008 Year

1987

1988

1989

1990

1991

Haematopoietic Stem Cell Transplantation (HSCT) in Allogeneic Donor Relationship No. % No. % activity No. % Malaysia No. %continued No. %to increase at a steady pace which 8was100 reflected the increased of transplants Sibling 6 in100 21 100 number 5 100 11 92 performed year on year. This 5th0 annual attempts Unrelated 0 report 0 0 0 to provide 0 0an accurate 0 0 record 0 Marrow 0 0 in02008.0 Overall 0 0 0 HSCT 0 0 0 of the total number of HSCT performed access to remained PBSC / Marrow + PBSC 0 0 0 0 0 0 0 0 0 low at 6 per million population. 0 0 0 8

Cord blood / Marrow + cord Others 1.1 STOCK AND FLOW TOTAL

0 0 100

0 0 6

0 0 100

0 0 21

0 0 100

0 0 5

0 0 100

0 1 12

0 8 100

In 2008 a total of 181 HSCT were performed. Two new centres namely Hospital Year 1992 1993 1995 1996 Pulau Pinang and Hospital Universiti Sains Malaysia1994 started autologous HSCT Allogeneic Donor Relationship % No. % No. % No. % No. % making a total of 12 transplantNo. centres operating in Malaysia. The Adult Transplant Sibling 20 100 18 100 22 92 29 100 26 100 team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in Unrelated 0 0 0 0 0 0 0 0 0 0 December 2006, has performed the most number of HSCT in 2008 contributing 31% Marrow 0 0 0 0 0 0 0 0 0 0 of the total national transplant activity. PBSC / Marrow + PBSC 0 0 0 0 0 0 0 0 0 0 0

Cord blood / Marrow + cord

Table Others 1.1.1: Stock and Flow of Blood 0 0and Marrow 0 0 Transplantation, 2 8 01987-2008 0 0 Year 1987 1988 TOTAL New transplant 8 6 patients Year Deaths 1 1 Allogeneic Donor Relationship Lost to follow0 0 Sibling up Unrelated Alive at 31st 7 12 Marrow December PBSC / Marrow + PBSC

cord Year Cord blood / Marrow 1998 +1999 Others New transplant 49 62 patients TOTAL Deaths 17 16 Lost Yearto follow0 0 up AllogeneicstDonor Relationship Alive at 31 167 213 Sibling December Unrelated Marrow PBSC / Marrow + PBSC Cord blood / Marrow + cord Others TOTAL Year Allogeneic Donor Relationship Sibling Unrelated Marrow PBSC / Marrow + PBSC Cord blood / Marrow + cord Others TOTAL

198920 1990 100 22 5 6

1997 6 No. %

0 26 096 1 4 28 0 270 0 0 100 20001 2001 0 0 94 108 27 100 31 47 0

20020 No. %

27671 337 95 4 5 0 0 0 0 4 100 0 0 75 100 2007 No. %

65 87 10 13 1 10 2 20 7 70 0 0 75 100 *excluding autologous, including syngeneic

1991 1992 18 100 12 21 1998 2 No. %

0 0 32 100 0 0 38 0 057 0 0 0 0 2002 2003 0 0 114 128 32 100 34 56 0 2003 0

No.

417 80 3 0 0 3 0 83

489 96 4 0 0 100 0 100

2008 No. %

102 13 0 5 8 0 115

7 29

89 11 0 38 62 0 100

1993 100 1994 291995100 1996 24 26 19 25 30 28

1999 5 No. %

440 1000 0 0 67 0 087 0 0 0 0 2004 2005 0 0 140 148 44 100 52 61 02004

No.

577 90 664 81 9 10 1 11 2 22 6 67 0 0 90 100 Total No. %

953 63 6 11 46 3 1019

94 6 10 17 73 0 100

2000 17 No. %

2001 15 No. %

55 0 98 072 1 2 3 100 117 0 0 0 0 0 0 1 2006100 2007 3 0 0 0 136 149 56 100 75 42 50

2005 0 No. %

0 0 1997 100 33

0 96 4 135 0 0 100 2008 0 181 100 71

0 2006 0 No.

83 75891 857 76 8 9 11 2 25 2 1 13 1 5 63 8 0 0 0 91 100 87

967 87 13 18 9 73 0 100

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BLOOD AND MARROW TRANSPLANTATION

1.4 TRANSPLANT OUTCOMES Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 A total of 71 deaths were reported for the 181 HSCT in 2008 making the mortality New patients 31st Decby sepsis in rate 39%. Underlying disease contributed to 51% of theseAlive deathsatfollowed 20% and graft-versus-host disease in 10%. 1,000

Number of patients (n)

Paediatric patients had better survival rates as shown in Figure 1.4.3. The survival curve for the most recent transplants (1999-2008) compared with the previous decade 800 is inferior most probably because older patients (hence higher risk) had access to HSCT and more complicated unrelated donor HSCT had been undertaken. 600 Table 1.4.1: Distribution of Patients by Cause of Death, 1987-2008 Year 1987 1988 1989 1990 1991 Cause of death No. % No. % No. % No. % No. % 400 Sepsis 1 100 0 0 0 0 0 0 1 100 GVHD 0 0 0 0 0 0 1 17 0 0 Underlying disease 0 0 0 0 6 100 5 83 0 0 200 Haemorrhage 0 0 1 100 0 0 0 0 0 0 VOD 0 0 0 0 0 0 0 0 0 0 Organ Failure 0 0 0 0 0 0 0 0 0 0 0 Interstitial pneumonitis 0 92 93 0 94 95 0 96 97 0 98 99 0 00 01 0 02 03 0 04 05 0 06 070 08 0 87 88 89 90 91 Year Secondary malignancy 0 0 0 0 0 0 0 0 0 0 Others 0 0 0 0 0 0 0 0 0 0 Unknown 0 0 0 0 0 0 0 0 0 0 TOTAL 1 100 1 100 6 100 6 100 1 100 Year Cause of death Sepsis GVHD Underlying disease Haemorrhage VOD Organ Failure Interstitial pneumonitis Secondary malignancy Others Unknown TOTAL

1992 No. % 1 50 0 0 0 0 0 0 0 0 1 50 0 0 0 0 0 0 0 0 2 100

1993 No. % 2 22 0 0 6 67 1 11 0 0 0 0 0 0 0 0 0 0 0 0 9 100

30 8

1994 No. % 1 20 0 0 3 60 0 0 0 0 1 20 0 0 0 0 0 0 0 0 5 100

1995 No. % 4 24 4 24 3 18 2 12 1 6 2 12 0 0 1 6 0 0 0 0 17 100

1996 No. % 6 55 0 0 3 27 1 9 1 9 0 0 0 0 0 0 0 0 0 0 11 100

FifthReport Report Fifth Report ofof thethe Fifth of the National Transplant Registry 2008 National Transplant Registry 2008 National Transplant Registry 2008

BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION BLOOD

1.0 INTRODUCTION 1997 Year No. % Cause of death

1998

1999

2000

2001

No.

0 0

0 1

0 6

1 0

3 0

2 0

4 0

Haematopoietic 5Stem 33 Cell Transplantation (HSCT) activity 2in Malaysia continued to Sepsis 1 6 6 38 6 4 9 increase at a steady pace which was reflected in the increased number of transplants GVHD 0 0 2 12 1 6 2 6 4 9 performed year on year. This 5th annual report attempts to provide an accurate record Underlying disease 9 60 11 65 7 44 22 71 33 70 of the total number of HSCT performed in 2008. Overall access to HSCT remained Haemorrhage 0 0 1 6 0 0 3 10 2 4 low at 6 per million population. 0 0 1 7 1.1 STOCK AND FLOW Interstitial 0 0 pneumonitis VOD

Organ Failure Secondary In 2008 malignancy

a total of 181 HSCT were performed. Two new centres namely Hospital 0 0 0 0 0 0 0 0 0 0 Pulau Pinang and Hospital Universiti Sains Malaysia started autologous HSCT Others 0 0 0 0 1 6 0 0 0 0 making a total of 12 transplant centres operating in Malaysia. The Adult Transplant Unknown 0 0 1 6 0 0 0 0 0 team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang 0in TOTAL 100 17 100 16 47 100 December 2006,15has performed the most number of100 HSCT 31 in 2008100 contributing 31% of the total national transplant activity. 2002

Year

Cause death Tableof1.1.1: Sepsis Year

patients disease Underlying Deaths Haemorrhage

Lost to followup Organ AliveFailure at 31st Interstitial December VOD

pneumonitis Secondary Year malignancy

Others New transplant

patients Unknown

Deaths Lost to followup Year Alive at 31st Cause of death December TOTAL

Sepsis GVHD Underlying disease VOD Organ Failure Interstitial pneumonitis Secondary malignancy Others Unknown TOTAL

2004

2005

2006

No. % No. % No. % No. Stock and Flow ofNo. Blood % and Marrow Transplantation, 1987-2008

GVHD New transplant

Haemorrhage

2003

6 1987 3 8 21 1 0 00 3 7 0

18 1988 9 6 62 1 0 00 9 12 0

15 1989 5 22 31 6 0 00 2 28 1

27 1990 9 5 55 6 0 00 4 27 2

131994 21 1995 7 11 25 30 30 49 5 17 2 3 0 0 00 1 2 87 100 2 3

8 1996 2 28 28 11 1 30 0 117 0

19 1997 5 33 67 15 2 70 0 135 0

0 1998 049 1 17 34 0

0 1999 062 3 16 100 0

0 2000 940 2 31 56 0

0 20020 2003 0 2004 02005 02006 2001 1080 1140 128 0 140 3 148 5136 4 3 6 3 5 47 34 56 52 61 42 100 52 100 61 100 0 0 0 0 0 0

0 2007 0149 0 50 42 0

0 2008 0 181 0 71 100 0

167 No.

213 %

276 No.

337 %

857

967

6 1 27 1 0 0

12 2 54 2 0 0

14 7 36 3 3 0

20 10 51 4 4 0

107 48 308 20 11 12

19 9 56 4 2 2

0 11 4 50

0 22 8 100

0 5 2 71

0 7 3 100

1 20 16 551

0 4 3 100

2007

2008

11 199221 1993 1991 9 17 12 21 19 27 52 1 2 9 2 4 00 0 0 0 0 0 38 57 67 0 0

Total

417 No. 489 % 577

7 31

664

758

Fifth Report Report of the the Fifth Report of National Transplant Registry 2008 2008 National Transplant Registry

BLOOD AND MARROW TRANSPLANTATION

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Figure 1.4.1: Patient Survival by Year of Transplant, 1987-2008 1.00

New patients

Alive at 31st Dec

800

0.50

NumberCumulative of patientssurvival (n)

0.75

1,000

0.25

600 400

0.00

200 0

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years

87 88 89 90 91Year 92 93 94 95 96 97 98 99 00 Year 01 021993-1998 03 04 05 06 07 08 1987-1992 Year Year 1999-2008

0.00

0.25

Cumulative survival 0.50 0.75

1.00

Figure 1.4.2: Patient Survival by Gender, 1987-2008

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years Male

32 8

Female

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BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.00

1.0 INTRODUCTION Figure 1.4.3: Patient Survival by Age Group, 1987-2008

Cumulative survival 0.25 0.50 0.75

0.00

In 2008 a total of 181 HSCT were performed. Two new centres namely Hospital Pulau Pinang and Hospital Universiti Sains Malaysia started autologous HSCT making a total of 12 transplant centres operating in Malaysia. The Adult Transplant team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in December 2006, has performed the most number of HSCT in 2008 contributing 31% of the total national transplant activity. Table 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 0 1 1987 2 3 1988 4 5 1989 6 71990 8 91991 10 11 13 141994 15 161995 17 181996 19 20 Year 199212 1993 1997 Duration in years

1.00

New transplant 8 6 22 5 12 21 19 25 30 patients 0-9 years 10-19 years Deaths 1 1 6 6 2 9 5 17 20-39 years1 Â&#x2022;40 years Lost to follow0 0 0 0 0 0 0 0 0 up Alive at 31st 7 12 28 27 38 57 67 87 100 December Figure 1.4.4: Patient Survival by Type of Transplant, 1987-2008

117

135

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

0.00

0.25

Cumulative survival 0.50 0.75

Year New transplant patients Deaths Lost to followup Alive at 31st December

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years

Allogeneic + Syngeneic

7 33

Autologous

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Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 1.5 DISEASE-FREE SURVIVAL patients Alive at 31st Dec Figures 1.5.1 to 1.5.7 show theNew disease free survival for individual diseases while Figures 1.5.8 to 1.5.13 show the breakdown between paediatric and adult patients. 1,000 Superior survival was seen in adults for acute lymphoblastic leukaemia and aplastic anaemia. Cumulative survival Number of patients (n) 0.50 0.75 1.00

Figure 800 1.5.1: Disease-free Survival for Acute Myeloid Leukaemia, 1987-2008 (Allogeneic vs. Autologous) 600 400 200 0

0.00

0.25

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Year

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years

Allogeneic

34 8

Autologous

FifthReport Report Fifth Report ofof thethe Fifth of the National Transplant Registry 2008 National Transplant Registry 2008 National Transplant Registry 2008

BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION BLOOD

Cumulative survival 0.50 0.75

1.00

1.0 INTRODUCTION Figure 1.5.2: Disease-free Survival for Acute Lymphoblastic Leukaemia, 1987-2008 (Allogeneic) Haematopoietic Stem Cell Transplantation (HSCT) activity in Malaysia continued to increase at a steady pace which was reflected in the increased number of transplants performed year on year. This 5th annual report attempts to provide an accurate record of the total number of HSCT performed in 2008. Overall access to HSCT remained low at 6 per million population. 1.1 STOCK AND FLOW

0.25

Figure 1.5.3: Disease-free Survival for Thalassaemia, 1987-2008 (Allogeneic) 1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

0.00

0.25

Cumulative survival 0.50 0.75

1.00

Year New transplant patients Deaths Lost to followup Alive at 31st December

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years Allogeneic

7 35

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BLOOD AND MARROW TRANSPLANTATION

1.00

Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Figure 1.5.4: Disease-free Survival for Non-Hodgkin’s Lymphoma, 1987-2008 (Allogeneic vs. Autologous) New patients Alive at 31st Dec

800 600

0.50

Cumulative survival Number of patients (n)

0.75

1,000

0.25

400

0.00

200 0

1 87288 389 90 4 91 5 92 6 93794895 96 9 97 10 98 11 99 1200130114 16 05 1706180719 02 15 03 04 08 20 Duration in years

Year

Allogeneic

Autologous

0.00

0.25

Cumulative survival 0.50 0.75

1.00

Figure 1.5.5 Disease-free Survival for Hodgkin’s Disease, 1987-2008 (Autologous)

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years Autologous

36 8

FifthReport Report Fifth Report ofof thethe Fifth of the National Transplant Registry 2008 National Transplant Registry 2008 National Transplant Registry 2008

BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION BLOOD

Cumulative survival 0.50 0.75

1.00

1.0 INTRODUCTION Figure 1.5.6: Disease-free Survival for Chronic Myeloid Leukaemia, 1987-2008 (Allogeneic) Haematopoietic Stem Cell Transplantation (HSCT) activity in Malaysia continued to increase at a steady pace which was reflected in the increased number of transplants performed year on year. This 5th annual report attempts to provide an accurate record of the total number of HSCT performed in 2008. Overall access to HSCT remained low at 6 per million population. 1.1 STOCK AND FLOW

0.25

Year 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 New transplant 8 6 22 5 12 21 19 25 30 28 33 patients 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Deaths 1 1 6 6 Duration 1 in years 2 9 5 17 11 15 Lost to follow0 0 0 0 0Allogeneic 0 0 0 0 0 0 up Alive at 31st 7 12 28 27 38 57 67 87 100 117 135 December Year 1.5.7: Disease-free 1998 1999Survival 2000 for 2001Aplastic 2002 Anaemia, 2003 2004 2005 2006 2007 2008 Figure 1987-2008 (Allogeneic) 49

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

0.00

Cumulative survival 0.25 0.50 0.75

1.00

New transplant patients Deaths Lost to followup Alive at 31st December

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years Allogeneic

7 37

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Figure 1.1.1: 1.5.8: Stock Disease-free Survival by Age Group for Acute Myeloid1987-2008 Leukaemia, and Flow of Blood and Marrow Transplantation, 1987-2008 1.00

New patients

Alive at 31st Dec

800

0.50

Cumulative survival Number of patients (n)

0.75

1,000

600

0.25

400

0.00

200 00

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 PaediatricYear Adult

Paediatric is defined as age d18 years and adult age >18 years

0.00

0.25

Cumulative survival 0.50 0.75

1.00

Figure 1.5.9: Disease-free Survival by Age Group for Acute Lymphoblastic Leukaemia, 1987-2008

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years Paediatric

Pediatric is defined as age d18 years and adult age >18 years

38 8

Adult

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1.00

1.0 INTRODUCTION Figure 1.5.10: Disease-free Survival by Age Group for Thalassaemia, 1987-2008

Cumulative survival 0.50 0.75

0.25

Year 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 New transplant 8 6 22 5 12 21 19 25 30 28 33 patients 0 1 21 3 41 5 66 7 6 8 9 1 10 112 12 13 Deaths 9 14 515 16 1717 181119 2015 Duration in years Lost to follow0 0 0 0 0 0 0 0 0 0 0 up Pediatric isstdefined as age d18 years and adult age >18 years Alive at 31 7 12 28 27 38 57 67 87 100 117 135 December

Figure 1.5.11: Disease-free Survival by Age Group for Non-Hodgkinâ&#x20AC;&#x2122;s Lymphoma, Year 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 1987-2008 49

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

0.00

Cumulative survival 0.25 0.50 0.75

1.00

New transplant patients Deaths Lost to followup Alive at 31st December

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years Paediatric

Pediatric is defined as age d18 years and adult age >18 years

7 39

Adult

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Figure 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008 Figure 1.5.12: Disease-free Survival by Age Group for Hodgkinâ&#x20AC;&#x2122;s Disease, 1987-2008 Alive at 31st Dec

1.00

New patients 1,000

600

0.50

Cumulative survival Number of patients (n)

0.75

800

0.25

400

0.00

200 00

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years

87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 PaediatricYear Adult

Paediatric is defined as age d18 years and adult age >18 years

0.00

Cumulative survival 0.25 0.50 0.75

1.00

Figure 1.5.13: Disease-free Survival by Age Group for Chronic Myeloid Leukaemia, 1987-2008

8 9 10 11 12 13 14 15 16 17 18 19 20 Duration in years Paediatric

40 8

Adult

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BLOOD BLOOD AND AND MARROW MARROW TRANSPLANTATION TRANSPLANTATION

1.0 INTRODUCTION Figure 1.5.14: Disease-free Survival by Age Group for Aplastic Anaemia, 1987-2008

Cumulative survival 0.25 0.50 0.75

1.00

Haematopoietic Stem Cell Transplantation (HSCT) activity in Malaysia continued to increase at a steady pace which was reflected in the increased number of transplants performed year on year. This 5th annual report attempts to provide an accurate record of the total number of HSCT performed in 2008. Overall access to HSCT remained low at 6 per million population. 1.1 STOCK AND FLOW In 2008 a total of 181 HSCT were performed. Two new centres namely Hospital Pulau Pinang and Hospital Universiti Sains Malaysia started autologous HSCT making a total of 12 transplant centres operating in Malaysia. The Adult Transplant team which operated in Hospital Kuala Lumpur shifted to Hospital Ampang in December 2006, has performed the most number of HSCT in 2008 contributing 31% of the total national transplant activity. 0.00

Table 1.1.1: Stock and Flow of Blood and Marrow Transplantation, 1987-2008

Year 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 New transplant 8 6 22 5 Duration 12 in years 21 19 25 30 28 33 patients Deaths 1 1 6 6Paediatric 1 2 9 Adult5 17 11 15 Lost to follow0 0 0 0 0 0 0 0 0 0 0 up st Pediatric as age d18 years and adult age >18 years Alive at is 31defined 7 12 28 27 38 57 67 87 100 117 135 December Year New transplant patients Deaths Lost to followup Alive at 31st December

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

108

114

128

140

148

136

149

181

167

213

276

337

417

489

577

664

758

857

967

7 41

CHAPTER 2 CORNEAL TRANSPLANTATION Editors: Dr Shamala Retnasabapathy Dr Chandramalar Santhirathelagan Expert Panel: Dr Shamala Retnasabapathy (Chairperson) Dr Chandramalar Santhirathelagan Dr Choong Yean Yaw Dr Michael Law Sie Haur Prof Dato’ Dr Veera Ramani Dr Thiageswari Umapathy Assoc Prof Dr Mohtar Ibrahim Contents 2.0 Introduction 2.1 Corneal Transplant Activities and Trends 1998-2008 x Transplant Rates x Type of Transplant 2.2 Recipients’ Characteristics 1998-2008 x Demographics x Primary Diagnosis 2.3 Transplant Practices 2004 - 2008 x Recipient Details x Donor Details x Transplant Practices 2.4 Corneal Transplant Outcome 2004-2008 x Outcome - Graft Survival x Outome - Vision 2.5 Post Corneal Transplant Complications 2004-2008

Fifth Report of the FifthRegistry Report of the National Transplant 2008 FifthRegistry Report of the National Transplant 2008 National Transplant Registry 2008

CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

List of Tables List of2.1.1: Tables Table Number of Corneal Transplantation and Transplant Rate per million Table 2.1.1:population Number of(pmp), Corneal Transplantation and Transplant Rate per million 1998-2008.........................................................................46 (pmp), Transplant, 1998-2008.........................................................................46 Table 2.1.2: population Types of Corneal 1998-2008.......................................................47 Table 2.1.2: Types of Corneal Transplant, 1998-2008.......................................................47 Table 2.2.1: Gender Distribution, 1998-2008....................................................................48 Table 2.2.2: 2.2.1: Ethnic GenderDistribution, Distribution,1998-2008......................................................................48 1998-2008....................................................................48 Table Table 2.2.2: Ethnic Distribution, 1998-2008......................................................................48 Table 2.2.3: Age Distribution of Corneal Transplant Recipient Patients, 1998-2008........49 Table 2.2.4: 2.2.3: Primary Age Distribution of1998-2008.......................................................................50 Corneal Transplant Recipient Patients, 1998-2008........49 Table Diagnosis, Table 2.2.4: Primary Diagnosis, 1998-2008.......................................................................50 Table 2.2.5: Indications of Corneal Transplant, 2004-2008 ..............................................51 Table 2.3.1.1: 2.2.5: Indications of Corneal ..............................................51 Table No of Previous GraftsTransplant, in Grafted 2004-2008 Eye, 2004-2008 .....................................52 Table 2.3.1.2: 2.3.1.1: Ocular No of Previous Grafts2004-2008 in Grafted ...............................................................52 Eye, 2004-2008 .....................................52 Table Co-morbidity, Table 2.3.1.2: Ocular Co-morbidity, 2004-2008 ...............................................................52 Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 Table 2.3.2.1: 2.3.1.3: Source Pre-operative Vision, 2004-2008................................................................53 Table of Donor Cornea Tissue, 2004-2008 ..............................................54 Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 Table 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 Table 2.3.2.3: 2.3.2.2: Preservation Donor Age Distribution, 2004-2008...........................................................55 Table Media, 2004-2008..................................................................56 Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Table 2.3.3.1: 2.3.2.4: Types Cause of of Surgeries, Death in Corneal Donors, 2004-2008..........................................57 Table 2004-2008...................................................................58 Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: 2.3.3.2: Recipient Types of Combined Surgeries, .................................................58 Table Cornea Trephine Size,2004-2008 2004-2008..............................................59 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 2004Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 2008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.3.3.5: Suture 2004-2008.....................................................................60 Table 2.4.1: Stock andTechnique, Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: 2.4.1: Stock Flow -2004-2008 Graft Status (Whole Database)..........................................61 Table Graftand Survival, ..........................................................................62 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: 2.4.2.2: Graft Graft Survival Survival by by Gender, Optical and Non-optical Indication, 2004-2008 ............63 Table 2004-2008 ........................................................64 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 Table 2.4.2.5: 2.4.2.4: Causes Graft Survival Age, 2004-2008 .............................................................65 Table of Graftby Failure...............................................................................66 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table 2.4.3.2: 2.4.3.1: Unaided Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: 2.4.3.2: Unaided Unaided Vision Visual for Outcome Cornea Transplant Surgery......................68 Table OpticalAfter and Non Optical Cases ...................................69 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: 2.5.1: Post Post Transplant Transplant Graft Complications Table Rejection......................................................................70 Types..........................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures List of Figures Figure 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 .............................................54 Figure 2.3.2.3: 2.3.2.1: Preservation Source of Donor Cornea Tissue,................................................................56 2004-2008 .............................................54 Figure Media, 2004-2008 Figure 2.4.2.1: 2.3.2.3: Graft Preservation Media, 2004-2008 ................................................................56 Figure Survival, 2004-2008.........................................................................62 Figure 2.4.2.1: Graft Survival, 2004-2008.........................................................................62 Figure 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008...........63 Figure 2.4.2.3: 2.4.2.2: Graft Graft Survival Survival by by Gender, Optical and Non-optical Indication, 2004-2008...........63 Figure 2004-2008.......................................................64 Figure 2.4.2.3: Graft Survival by Gender, 2004-2008.......................................................64 Figure 2.4.2.4: Graft Survival by Age, 2004-2008 ............................................................65 Figure 2.4.3.2: 2.4.2.4: Unaided Graft Survival Age, 2004-2008 ............................................................65 Figure Visualby Outcome After Corneal Transplant Surgery ...................68 Figure 2.4.3.2: Unaided Visual Outcome After Corneal Transplant Surgery ...................68 Figure 2.4.3.3: Cumulative Probability for Unaided Vision in Grafts...............................69 Figure 2.4.3.3: Cumulative Probability for Unaided Vision in Grafts...............................69

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CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

2.0 INTRODUCTION 2.0 INTRODUCTION Corneal transplantation surgery allows restoration of vision in patients with corneal Corneal transplantation surgery allows restoration of back visiontointhepatients corneal blindness. Corneal transplantation in Malaysia dates 1970’s.with Today it is blindness. Corneal transplantation in Malaysia dates back to the 1970’s. Today it is performed by ophthalmologists both in the government and private sectors with each centre performed by data ophthalmologists both in Transplant the government and private sectors with each centre contributing towards the National Registry. contributing data towards the National Transplant Registry. The National Transplant Registry (NTR) was established in December 2003. The corneal The National Transplant was established in December 2003.ofThe transplant section of theRegistry NTR is(NTR) a systematic centralised data collection all corneal corneal transplant section of the NTR is a systematic centralised data collection of all corneal transplantations performed in the country. transplantations performed in the country. A total of 46 centres registered and agreed to provide information on retrospective and Aprospective total of 46corneal centrestransplant registeredactivities. and agreed to provide informationsurgeons on retrospective andin A total of 75 contributing participated prospective corneal transplant activities. A total of 75 contributing surgeons participated in the NTR – Corneal Transplant section. Participation was on a voluntary basis. the NTR – Corneal Transplant section. Participation was on a voluntary basis. Retrospective data (from 1998 to 2003) on corneal transplant activities were collected to Retrospective dataof(from 1998 to 2003)surgery on corneal weredata collected to identify the trend corneal transplant in the transplant recent past.activities Prospective (from the identify the trend of corneal transplant surgery in the recent past. Prospective data (from the year 2004) on corneal transplant activities involved gathering information on all cornea year 2004) performed on cornealintransplant involved gathering on Transplant all cornea transplants Malaysia activities on two forms. The first form isinformation the i) Corneal transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant Notification Form (Form N-cds) which is completed at the time of surgery and gathers Notification N-cds) which is completed at donor. the time of second surgeryform and isgathers information Form on the (Form recipient, operative procedure and the The the ii) information on the recipient, operative procedure and the donor. The second form is the Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of ii) 12 Corneal Transplant (Form O-cds) completed at death the end of 12to months and annually Outcome thereafter. Form Follow-up only ceaseswhich upon is failure of graft, or loss months andofannually thereafter. Follow-up only ceases upon failure of graft, death or loss to follow-up the patient. follow-up of the patient.

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CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

The Corneal section of the NTR will be discussed under 5 sections. List of Tables Table 2.1.1: Number of Corneal Transplantation Rate per million over 9 Section 2.1 and Section 2.2 covers notification and dataTransplant on corneal transplantation (pmp), Effort 1998-2008.........................................................................46 years from population 1998 to 2007. was made to ensure that all cases of corneal Table 2.1.2: Types of Corneal Transplant, 1998-2008.......................................................47 transplantation were reported. To the best of our knowledge, this report provides Table 2.2.1: on Gender Distribution, 1998-2008....................................................................48 information all corneal transplants performed in the country. Table 2.2.2: Ethnic Distribution, 1998-2008......................................................................48 Table 2.2.3: Distribution of Corneal Transplant 1998-2008........49 Section 2.3 Age covers prospective notification data onRecipient corneal Patients, transplantation performed Table 2.2.4: Primary Diagnosis, 1998-2008.......................................................................50 (from 2004 onwards) Table 2.2.5: Indications of Corneal Transplant, 2004-2008 ..............................................51 Table 2.3.1.1: No ofprospective Previous Grafts in Grafted 2004-2008 .....................................52 Section 2.4 covers outcome data onEye, corneal transplantation performed (from Table 2.3.1.2: Ocular Co-morbidity, 2004-2008 ...............................................................52 2004 onwards). Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 Table 2.3.2.1: Source of Donor Cornea Tissue, Section 2.5 covers prospective outcome data 2004-2008 on corneal ..............................................54 transplantation complications Table 2004 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 (from onwards). Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

Figure 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 .............................................54 Figure 2.3.2.3: Preservation Media, 2004-2008 ................................................................56 Figure 2.4.2.1: Graft Survival, 2004-2008.........................................................................62 Figure 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008...........63 Figure 2.4.2.3: Graft Survival by Gender, 2004-2008.......................................................64 Figure 2.4.2.4: Graft Survival by Age, 2004-2008 ............................................................65 Figure 2.4.3.2: Unaided Visual Outcome After Corneal Transplant Surgery ...................68 Figure 2.4.3.3: Cumulative Probability for Unaided Vision in Grafts...............................69

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CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

2.1 CORNEAL TRANSPLANT ACTIVITIES AND TRENDS (1998 – 2008) 2.0 INTRODUCTION The number of cornea transplants performed between 1998 and 2008 showed an increasing Corneal transplantation of number vision inof patients with corneal trend from 119 in 1998surgery to 230 allows in 2008.restoration The highest corneal transplantation blindness. Corneal transplantation in Malaysia dates back to the 1970’s. Today it is performed was in the year 2008 (Table 2.1.1). performed by ophthalmologists both in the government and private sectors with each centre contributing towards the Transplant Penetrating data keratoplasty wasNational the most frequent Registry. type of cornea transplant surgery and was performed in 91% of cases (Table 2.1.2). The National Transplant Registry (NTR) was established in December 2003. The corneal transplant section of the NTR is a systematic centralised data collection of all corneal transplantations performed in the country. Table 2.1.1: Number of Corneal Transplantation and Transplant Rate per million population (pmp), 1998-2008 AYear total of 46 centres registered agreed information on retrospective 1998 1999and2000 2001to provide 2002 2003 2004 2005 2006 2007 and 2008 No. of new transplants 119 122 126 A total 221 of203 165 184 surgeons 192 177 196 230 prospective corneal transplant activities. 75 contributing participated in New transplant rate, pmp 5 5 5 9 8 7 7 7 7 7 8 the NTR – Corneal Transplant section. Participation was on a voluntary basis. Retrospective data (from 1998 to 2003) on corneal transplant activities were collected to identify the trend of corneal transplant surgery in the recent past. Prospective data (from the year 2004) on corneal transplant activities involved gathering information on all cornea transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant Notification Form (Form N-cds) which is completed at the time of surgery and gathers information on the recipient, operative procedure and the donor. The second form is the ii) Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of 12 months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to follow-up of the patient.

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CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

List of Tables Table 2.1.1: Number of Corneal Transplantation and Transplant Rate per million population (pmp), 1998-2008.........................................................................46 Table 2.1.2: Types of Corneal Transplant, 1998-2008.......................................................47 Table 2.2.1: Gender Distribution, 1998-2008....................................................................48 Table 2.2.2: Ethnic Distribution, 1998-2008......................................................................48 Table 2.2.3: Age Distribution of Corneal Transplant Recipient Patients, 1998-2008........49 Table 2.2.4: Primary Diagnosis, 1998-2008.......................................................................50 Table 2.2.5: Indications of Corneal Transplant, 2004-2008 ..............................................51 Table 2.3.1.1: No of Previous Grafts in Grafted Eye, 2004-2008 .....................................52 Table 2.3.1.2: Ocular Co-morbidity, 2004-2008 ...............................................................52 Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 Table 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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Fifth Report of the FifthNational Report ofTransplant the of the Registry 2008 Fifth Report National Transplant Registry 2008 2008 National Transplant Registry

CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

2.0 INTRODUCTION Corneal transplantation surgery allows restoration of vision in patients with corneal blindness. Corneal transplantation in Malaysia dates back to the 1970â&#x20AC;&#x2122;s. Today it is performed by ophthalmologists both in the government and private sectors with each centre contributing data towards the National Transplant Registry. The National Transplant Registry (NTR) was established in December 2003. The corneal transplant section of the NTR is a systematic centralised data collection of all corneal transplantations performed in the country. A total of 46 centres registered and agreed to provide information on retrospective and prospective corneal transplant activities. A total of 75 contributing surgeons participated in the NTR â&#x20AC;&#x201C; Corneal Transplant section. Participation was on a voluntary basis. Retrospective data (from 1998 to 2003) on corneal transplant activities were collected to identify the trend of corneal transplant surgery in the recent past. Prospective data (from the year 2004) on corneal transplant activities involved gathering information on all cornea transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant Notification Form (Form N-cds) which is completed at the time of surgery and gathers information on the recipient, operative procedure and the donor. The second form is the ii) Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of 12 months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to follow-up of the patient.

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Table 2.2.5: Indications of Corneal Transplant, 2004-2008 List of Tables 2004 2005 2006 2007 2008 TOTAL (N=184) (N=192) (N=177) (N=196) (N=230) (N=979) Table 2.1.1: Number of Corneal Transplantation and Transplant Rate per million Indication of transplant % No. % No. % No. % No. % No. % population (pmp),No. 1998-2008.........................................................................46 Table 2.1.2: Types of Corneal Transplant, Optical 120 65 1351998-2008.......................................................47 70 124 70 139 71 154 67 672 69 Table 2.2.1: Gender Distribution, Tectonic 26 1998-2008....................................................................48 14 23 12 20 11 17 9 25 11 111 11 Table 2.2.2: Ethnic Distribution, 1998-2008......................................................................48 Therapeutic 27 15 19 10 17 10 24 12 24 10 111 11 Table 2.2.3: Age Distribution of Corneal Transplant Recipient Patients, 1998-2008........49 Tectonic+Therapeutic 9 5 9 5 4 2 8 4 6 3 36 4 Table 2.2.4: Primary Diagnosis, 1998-2008.......................................................................50 Optical+Tectonic 1 1 1 1 1 1 0 0 1 0 4 0 Table 2.2.5: Indications of Corneal Transplant, 2004-2008 ..............................................51 Optical+Tectonic+Therapeutic 0 0 1 1 0 0 1 1 1 0 3 0 Table 2.3.1.1: No of Previous Grafts in Grafted Eye, 2004-2008 .....................................52 Optical+Therapeutic 0 0 2004-2008 0 0 ...............................................................52 5 3 6 3 7 3 18 2 Table 2.3.1.2: Ocular Co-morbidity, Optical+Others 0 0 2004-2008................................................................53 0 0 1 1 0 0 1 0 2 0 Table 2.3.1.3: Pre-operative Vision, Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 Therapeutic+Others 0 0 0 0 0 0 0 0 1 0 1 0 Table 2004-2008...........................................................55 Others2.3.2.2: Donor Age Distribution, 1 1 4 2 4 2 1 1 9 4 19 2 Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 No data 0 0 0 0 1 1 0 0 1 0 2 0 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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2.3 TRANSPLANT DATA, 2004-2008 2.0 INTRODUCTION 2.3.1 Recipient Data Corneal transplantation surgery allows vision Ocular in patients with corneal Regrafts were performed in 13% of restoration cases (Tableof2.3.1.1). co-morbidity was blindness. Corneal transplantation in Malaysia dates back to the 1970â&#x20AC;&#x2122;s. it is noted in 52% of the patients and corneal vascularisation was the most Today frequently performed by ophthalmologists encountered (Table 2.3.1.2).both in the government and private sectors with each centre contributing data towards the National Transplant Registry. From the data available 59% of the cases were legally blind (vision worse than 3/60) The prior National Transplant Registry (NTR) was established in December 2003. The corneal to corneal transplantation (Table 2.3.1.3). transplant section of the NTR is a systematic centralised data collection of all corneal transplantations performed in the country. Table 2.3.1.1: No of Previous Grafts in Grafted Eye, 2004-2008 A total of 46 centres 2004 registered and agreed to 2006 provide information on retrospective and 2005 2007 2008 TOTAL Year (N=138) activities. (N=192)A total(N=177) (N=196)surgeons (N=230) (N=933)in prospective corneal transplant of 75 contributing participated Graftâ&#x20AC;&#x201C; Corneal Transplant section. Participation was on a voluntary basis. the NTR No. % No. % No. % No. % No. % No. %

Number 0 123 89 171 89 160 90 161 82 201 87 816 87 Retrospective data (from 1998 to152003) 8on corneal transplant activities were collected to 1 11 8 15 8 30 15 21 10 92 10 identify the trend of corneal transplant surgery in the recent past. Prospective the 2 3 2 2 1 1 1 4 2 5 data 2 (from 15 2 year 32004) on corneal 0 transplant 0 1activities 1 involved 1 1gathering 0 information 0 0 on 0 all2 cornea 0 transplants performed1in Malaysia on 4 1 0 two 0forms. 0The first 0 form1 is the1i) Corneal 0 0 Transplant 2 0 Not available 0 0 0which0 is completed 0 0 at the0 time 0of surgery 1 0 and 1gathers 0 Notification Form (Form N-cds) Missing 0 0 3 2 0 0 0 0 2 1 5 1 information on the recipient, operative procedure and the donor. The second form is the ii)

Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of 12 months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to Tableof 2.3.1.2: Ocular Co-morbidity, 2004-2008 follow-up the patient. Year

2004 (N=138) No. %

2005 (N=192) No. %

Ocular co-morbidity Any ocular co-morbidity (a 88 64 103 to d below) a) Superficial corneal 44 50 48 vascularisation b) Deep corneal 42 48 39 vascularisation c) History of glaucoma 29 33 36 d) Current ocular 41 47 50 inflammation *Patient might have multiple ocular co-morbidities

2006 (N=177) No. %

2007 (N=196) No. %

2008 (N=230) No. %

TOTAL (N=933) No. %

126

488

259

162

208

237

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Table 2.3.1.3: Pre-operative Vision, 2004-2008 ListYear of Tables 2004 2005 2006 2007 2008 TOTAL (N=177) (N=196) Rate (N=230) (N=933) Table 2.1.1: Number(N=138) of Corneal(N=192) Transplantation and Transplant per million Unaided VA No. % No. % No. % No. % No. % No. % population (pmp), 1998-2008.........................................................................46 6/6 3 2 0 0 1 1 1 1 1 0 6 1 Table 2.1.2: Types of Corneal Transplant, 1998-2008.......................................................47 6/9 1 1 1 1 1 1 2 1 6 3 11 1 Table 2.2.1: Gender Distribution, 1998-2008....................................................................48 6/12 0 0 2 1 3 2 0 0 2 1 7 1 Table 2.2.2: Ethnic Distribution, 6/18 0 0 1 1998-2008......................................................................48 1 0 0 2 1 1 0 4 0 Table 2.2.3: Age Distribution of5 Corneal 1998-2008........49 6/24 3 2 3 Transplant 4 2 Recipient 2 1 Patients, 3 1 17 2 Table 2.2.4: Primary4 Diagnosis, 6/36 3 61998-2008.......................................................................50 3 5 3 3 2 5 2 23 2 6/60 7 16 Transplant, 8 17 2004-2008 10 11 ..............................................51 6 14 6 65 7 Table 2.2.5: Indications of5 Corneal 5/60 1 1 0 0 0 0 0 0 0 0 1 0 Table 2.3.1.1: No of Previous Grafts in Grafted Eye, 2004-2008 .....................................52 4/60 2 1 1 2 1 2 1 0 0 8 1 Table 2.3.1.2: Ocular3 Co-morbidity, 2004-2008 ...............................................................52 3/60 2 1 2 1 1 1 4 2 5 2 14 2 Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 2/60 1 1 2 1 4 2 1 1 2 1 10 1 Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 1/60 4 3 9 5 7 4 2 1 1 0 23 2 Table Distribution, CF2.3.2.2: Donor 47Age34 47 24 2004-2008...........................................................55 45 25 43 22 40 17 222 24 Table HM2.3.2.3: Preservation 47 34 Media, 46 2004-2008..................................................................56 24 37 21 48 24 47 20 225 24 PL 13 9 15 8 12 7 17 9 20 9 77 8 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 NPL 1 1 2004-2008...................................................................58 1 0 0 1 1 0 0 4 0 Table 2.3.3.1: Types2 of Surgeries, No data 0 0 38 20 38 21 57 29 83 36 216 23 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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2.3.2 Donor details 2.0 INTRODUCTION Eye Banks in the United States of America (USA) were the most frequent source of the corneal tissues (Table 2.3.2.1). The majority of donors were elderly patients with a Corneal transplantation surgery restoration of was vision in patients corneal with corneal median age of 57 years (Tableallows 2.3.2.2). Optisol GS the commonest tissue blindness. Corneal transplantation in Malaysia dates back to the 1970â&#x20AC;&#x2122;s. it is storage medium used at 76% (Table 2.3.2.3). The major cause of death ofToday the donors performed by ophthalmologists in the government and private sectors with each(15%) centre were related to the cardiac both or circulatory system (31%) followed by malignancy contributing data towards the National Transplant Registry. (Table 2.3.2.4). The National Transplant Registry (NTR) was established in December 2003. The corneal transplant the NTR is aCornea systematic centralised Table section 2.3.2.1: of Source of Donor Tissue, 2004-2008data collection of all corneal transplantations performed in the country. Year 2004 2005 2006 2007 2008 TOTAL

(N=138) (N=192) (N=177) (N=196) (N=230) (N=933) Source of No. % No. % No. % No. % No. % No. and % A total of 46 centres registered and agreed to provide information on retrospective donor prospective corneal transplant activities. A total of 75 contributing surgeons participated in Local 20 14 19 10 36 20 31 16 41 18 147 16 the NTR â&#x20AC;&#x201C; Corneal Transplant section. Participation was 56 on a voluntary basis. USA 95 69 133 69 98 114 58 150 65 590 64 Sri Lanka 22 16 38 20 41 23 51 26 36 16 188 20 Retrospective data (from on transplant were collected Others 0 1998 0 to 2003) 0 0 corneal 2 1 0 activities 0 2 1 4 0to identify the trend of corneal transplant No data 1 1 2 surgery 1 in the 0 recent 0 past. 0 Prospective 0 1 data 0 (from 4 the 0

year 2004) on corneal transplant activities involved gathering information on all cornea If Local, ethnic group: transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant Malay 0 0 4 21 1 3 16 0 0 7 Notification Form (Form N-cds) which is completed at the 5time of surgery and 10 gathers Chinese 14 70 8 42 12 33 16 52 22 54 72 49 information on the recipient, operative procedure and the donor. The13 second form is the ii) Indian 5 25 7 37 23 64 4 9 22 48 33 Corneal Transplant Outcome Form (Form O-cds) which is completed at the end Others 0 0 0 0 0 0 4 13 6 15 10of 12 7 months upon failure of6graft,4death No and data annually thereafter. 1 5 Follow-up 0 0only ceases 0 0 2 10 or 7loss 5to * In the there were a total of 184 corneal transplants performed but complete data set was only follow-up ofyear the 2004 patient. received for 138 patients

Figure 2.3.2.1: Source of Donor Corneal Tissue, 2004-2008 Local Sri Lanka

USA

70 60

Percent

50 40 30 20 10 0

2004

2005

2006 Year

54 44

2007

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Fifth Report of the Fifth Report of the National Transplant Registry 2008 FifthRegistry Report of the National Transplant 2008 National Transplant Registry 2008

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List of Tables Table 2.3.2.2: Donor Age Distribution, 2004-2008 Table Corneal Transplantation and Transplant2007 Rate per million Year2.1.1: Number of2004 2005 2006 2008 TOTAL (N=192) (N=177) (N=196) (N=230) (N=933) population(N=138) (pmp), 1998-2008.........................................................................46 Age 2.1.2: group Types of Corneal Transplant, 1998-2008.......................................................47 Table No. % No. % No. % No. % No. % No. % (years) Table 2.2.1: Gender Distribution, 1998-2008....................................................................48 0-9 2 1 3 2 2 1 2 1 7 3 16 2 Table 2.2.2: Ethnic Distribution, 1998-2008......................................................................48 10-19 6 4 4 2 9 5 5 3 7 3 31 3 Table 2.2.3: Age Distribution Transplant 20-39 11 8 of Corneal 7 4 11 Recipient 6 13Patients, 7 1998-2008........49 19 8 61 7 Table 2.2.4: Primary Diagnosis, 40-59 52 38 1998-2008.......................................................................50 89 46 81 46 83 42 79 34 384 41 Table 2.2.5: Indications of Corneal Transplant, 2004-2008 Â&#x2022;60 67 49 89 46 74 42 ..............................................51 93 47 118 51 441 47 Mean 56 58Grafted Eye, 562004-2008 .....................................52 57 56 57 Table 2.3.1.1: No of Previous Grafts in SD 2.3.1.2: Ocular Co-morbidity, 15 14 16 14 17 15 Table 2004-2008 ...............................................................52 Median 59 58 56 59 60 59 Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 Minimum 8 3 6 4 1 1 Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 Maximum 78 79 78 78 76 79 Table 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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Table 2.3.2.3: Preservation Media, 2004-2008 2.0 INTRODUCTION 2004 2005 2006 Year (N=138)

(N=192)

(N=177)

2007 (N=196)

2008 (N=230)

TOTAL (N=933)

Preservation Corneal transplantationNo.surgery restoration of withNo.corneal % allows No. % No. % vision No. in %patients No. % % media Corneal transplantation in Malaysia dates back to the 1970â&#x20AC;&#x2122;s. Today it is blindness. Optisol GS 110 80 both147 129 72 134 68 189with 82 each 709 centre 76 performed by ophthalmologists in the76government and private sectors MK Medium 22 16 37 19 40 23 51 26 34 15 184 19 contributing data towards the National Transplant Registry. Moist Chamber 4 3 3 2 7 4 8 4 4 2 26 3 Others 0 0 1 1 0 0 3 2 1 0 5 1 The National Transplant Registry (NTR) was established in December 2003. The corneal No data 2 1 4 2 1 1 0 0 2 1 9 1 transplant section of the NTR is a systematic centralised data collection of all corneal *Others (specify) Eusol-C

transplantations performed in the country.

A total of 46 centres registered and agreed to provide information on retrospective and Figure 2.3.2.3: Preservation Media, 2004-2008 prospective corneal transplant activities. A total of 75 contributing surgeons participated in MK Medium Optisol the NTR â&#x20AC;&#x201C; Corneal Transplant section. Participation was on a voluntary basis. Moist Chamber

Percent

Retrospective80 data (from 1998 to 2003) on corneal transplant activities were collected to identify the trend of corneal transplant surgery in the recent past. Prospective data (from the 70 year 2004) on corneal transplant activities involved gathering information on all cornea transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant 60 Notification Form (Form N-cds) which is completed at the time of surgery and gathers information on the recipient, operative procedure and the donor. The second form is the ii) 50 Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of 12 months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to 40 follow-up of the patient. 30 20 10 0

2004

2005

2.3.2.3: Preservation Media, 2004-2008

2006 Year

56 44

2007

Figure 2008

Fifth Report of the Fifth Report of the FifthRegistry Report of the National Transplant Registry 2008 National Transplant 2008 National Transplant Registry 2008

CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008 List of Tables Year 2004 2005 2006 2007 2008 TOTAL (N=192) (N=177) (N=196) (N=230) Table 2.1.1: Number of(N=138) Corneal Transplantation and Transplant Rate per million (N=933) Cause of death % 1998-2008.........................................................................46 No. % No. % No. % No. % No. % populationNo. (pmp), Cardiac / Table 2.1.2: Types of Corneal 47 34Transplant, 49 261998-2008.......................................................47 59 33 75 38 61 27 291 31 Circulatory System Table 2.2.1: Gender Distribution, 1998-2008....................................................................48 Cerebrovascular 17 12 1998-2008......................................................................48 25 13 11 6 23 12 35 15 111 12 Table 2.2.2: Ethnic Distribution, System Table 2.2.3: Age Distribution Transplant Recipient Malignancy 19 14of Corneal 31 16 25 14 26 Patients, 13 411998-2008........49 18 142 15 Trauma / Accident 20 15 1998-2008.......................................................................50 13 7 19 11 24 12 21 9 97 10 Table 2.2.4: Primary Diagnosis, Respiratory System 15of Corneal 11 8Transplant, 4 82004-2008 5 13 7 10 4 54 6 Table 2.2.5: Indications ..............................................51 Others 17 12 21 11 27 15 32 16 58 25 155 17 Table 2.3.1.1: No of Previous Grafts in Grafted Eye, 2004-2008 .....................................52 No data 3 2 45 23 28 16 3 2 4 2 83 9 Table 2.3.1.2: Ocular Co-morbidity, 2004-2008 ...............................................................52 Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 Table 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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2.3.3 Transplant Practices 2.0 INTRODUCTION Penetrating Keratoplasty (PK) was the commonest type of surgery performed (86%) (Table 2.3.3.1). Corneal transplantation was performed in combination with other Corneal transplantation restoration of vision corneal surgical procedures insurgery 19% ofallows cases. Cataract extraction, within orpatients without with intraocular blindness. Corneal transplantation in Malaysia dates back to the 1970â&#x20AC;&#x2122;s. Today lens implantation (IOL), was the commonest combined procedure (Table 2.3.3.2). it is performed by ophthalmologists both in the government and private sectors with each centre contributing data towards theranged National Transplant The recipient graft size from 2mm to Registry. 10mm, with the median recipient cornea graft size being 7.5mm.(Table 2.3.3.3). The majority of cases had the donor tissue overThe sized National Transplant Registry (NTR) established in December The corneal by 0.5mm (Table 2.3.3.4). The was commonest suturing technique2003. was interrupted transplant section of the NTR is a systematic centralised data collection of all corneal sutures (Table 2.3.3.5). transplantations performed in the country. A total 46 centres and 2004-2008 agreed to provide information on retrospective and Tableof2.3.3.1: Typesregistered of Surgeries, prospective corneal transplant activities. A 2005 total of 752006 contributing Year 2004 2007 surgeons 2008participated TOTAL in (N=138)Participation (N=192) was (N=177) (N=196) basis. (N=230) (N=933) the NTR â&#x20AC;&#x201C; Corneal Transplant section. on a voluntary

Type of surgery No. % No. % No. % No. % No. % No. % Penetrating Keratoplasty 87 173 90 153transplant 86 175activities 89 188were 82 collected 809 87 to Retrospective data (from 1998120 to 2003) on corneal Lamellar Keratoplasty 10 7 13 7 16 9 7 4 21 9 67 7 identify the trend of corneal transplant surgery in the recent past. Prospective data (from the Patch Graft for Corneal 2 1 3 2 5 3 10 5 12 5 32 3 yearPatch 2004) on Graftonforcorneal Scleral transplant 0 activities 0 1 involved 1 1 gathering 1 1 information 1 2 1 all5 cornea 1 transplants performed in Malaysia on two forms. The first form is the i) Corneal Cornea Scleral Keratoplasty 6 4 2 1 2 1 3 2 4 2 Transplant 17 2 Notification (Form N-cds) EndothelialForm keratoplasty 0 which 0 0is completed 0 0 at0 the 0time 0of surgery 3 1 and3 gathers 0 * In the year were a operative total of 184 procedure corneal transplants performed complete data set was only ii) information on2004 the there recipient, and the donor.but The second form is the received for 138 patients Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of 12

months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to follow-up of the patient. Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 2004 (N=138) No. %

2005 (N=192) No. %

Combined surgeries No. of patients with corneal 31 22 27 transplant surgery combined with another surgical procedure (a) Glaucoma surgery 2 6 3 (b) Cataract Extraction 16 52 13 (c ) IOL 14 45 10 (d) Cataract extraction and IOL 10 32 8 (e) Retinal Surgery + Internal 1 3 1 Tamponade (f) Anterior vitrectomy 9 29 3 (g) Others 5 16 8 *Patients may have more than one combined surgery

58 44

2006 (N=177) No. %

2007 (N=196) No. %

2008 (N=230) No. %

TOTAL (N=933) No. %

180

11 48 37 30

1 21 24 15

2 51 59 37

0 13 19 10

0 37 54 29

3 17 23 16

7 37 50 35

9 80 90 59

5 44 50 33

11 30

4 8

10 20

10 16

29 46

6 14

13 30

32 51

18 28

Fifth Report of the Fifth Report of 2008 the National Transplant Registry FifthRegistry Report of the National Transplant 2008 National Transplant Registry 2008

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Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008 List Yearof Tables 2004 2005 2006 2007 2008 TOTAL (N=138) (N=177) (N=196) Rate(N=230) Table 2.1.1: Number of Corneal(N=192) Transplantation and Transplant per million(N=933) Graft size, mm No. (pmp), % No. % No. % No. % No. % No. % population 1998-2008.........................................................................46 2 1 1 1 1 2 1 1 1 0 0 5 1 Table 2.1.2: Types of Corneal Transplant, 1998-2008.......................................................47 3 0 0 1 1 2 1 1 1 1 0 5 1 Table 2.2.1: Gender Distribution, 1998-2008....................................................................48 4 1 1 2 1 1 1 5 3 2 1 11 1 Table 2.2.2: Ethnic0Distribution, 5 0 0 1998-2008......................................................................48 0 0 0 1 1 1 0 2 0 Table of0 Corneal 5.5 2.2.3: Age Distribution 1 1 0 Transplant 0 0 Recipient 0 0Patients, 0 1998-2008........49 0 1 0 Table 2.2.4: Primary 6 3 Diagnosis, 2 0 1998-2008.......................................................................50 0 5 3 4 2 4 2 16 2 6.25 2.2.5: Indications 0 0 Corneal 1 1 0 2004-2008 0 0 ..............................................51 0 0 0 1 0 Table of Transplant, 6.5 2.3.1.1: No of 2 Previous 1 5 3 Grafted 4 2 2004-2008 8 4 .....................................52 7 3 26 3 Table Grafts in Eye, 6.7 0 0 0 0 0 0 0 0 0 0 0 0 Table 2.3.1.2: Ocular Co-morbidity, 2004-2008 ...............................................................52 6.75 1 1 3 2 2 1 1 1 1 0 8 1 Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 7 25 18 36 19 25 14 29 15 37 16 152 16 Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 7.2 0 0 0 0 0 0 0 0 0 0 0 0 Table 7.25 2.3.2.2: Donor 10 Age7 Distribution, 10 5 2004-2008...........................................................55 14 8 5 3 5 2 44 5 Table 7.5 2.3.2.3: Preservation 36 26 Media, 18 2004-2008..................................................................56 9 26 15 37 19 50 22 167 18 7.75 2.3.2.4: Cause 10 of Death 7 11 Corneal 6 6 32004-2008..........................................57 12 6 14 6 53 6 Table in Donors, 8 19 14 7 4 13 7 19 10 26 11 84 9 Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 8.15 0 0 0 0 0 0 0 0 0 0 0 0 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 8.25 4 3 4 2 5 3 4 2 4 2 21 2 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 8.5 6 4 6 3 2 1 11 6 10 4 35 4 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20048.75 0 0 1 1 0 0 0 0 0 0 1 0 2008 ................................................................................................................60 8.8 0 0 0 0 0 0 0 0 0 0 0 0 9 8 Technique, 6 3 2004-2008.....................................................................60 2 1 1 4 2 3 1 19 2 Table 2.3.3.5: Suture 9.5 0 0 2 1 0 0 0 0 1 0 3 0 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 10 2.4.2.1: Graft1 Survival, 1 0 0 ..........................................................................62 0 0 0 0 2 1 3 0 Table 2004-2008 11 0 0 0 0 0 0 0 0 1 0 1 0 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 12 0 0 0 0 0 0 0 0 1 0 1 0 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 No data 10 7 81 42 69 39 54 28 57 25 271 29 Table by Age, Mean 2.4.2.4: Graft Survival 7.5 7.3 2004-2008 7.2 .............................................................65 7.3 7.5 7.4 Table of Graft Failure...............................................................................66 SD 2.4.2.5: Causes0.9 1 1.1 1.1 0.9 1 Median 7.5 7.3 7.5 Unaided7.5 7.5 Table 2.4.3.1: Availability of Data7.3on Post Corneal Transplant Vision .............67 Minimum 2 2 2 2 3 2 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Maximum 10 Vision for9.5 12 12 Table 2.4.3.3: Unaided Optical and 9Non Optical9Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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Fifth Report of the Fifth Report of the National Transplant Fifth Report of the Registry 2008 National Transplant Registry 2008 2008 National Transplant Registry

CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042.0 INTRODUCTION 2008 2004

2005

2006

2007

2008

TOTAL

(N=138) (N=177) (N=196) (N=230) Corneal transplantation surgery allows(N=192) restoration of vision in patients with (N=933) corneal Difference in Graft size, blindness. Corneal transplantation in Malaysia dates back to the 1970â&#x20AC;&#x2122;s. Today No. % No. % No. % No. % No. % No. it %is mm performed by ophthalmologists both in the government and private sectors with each centre 9 7 Transplant 8 4 Registry. 8 5 12 6 19 8 56 6 Same Size contributing data towards the National 0.2

0.6

1.5

29 21 30 17 in 27 14 27 14 The National Transplant Registry (NTR)19 was10established December 2003.12The132 corneal 0.25 transplant section of the NTR is a systematic centralised data collection of all corneal 87 63 84 44 67 38 95 48 116 50 449 48 0.5 transplantations performed in the country. 0 0 0 0 0 0 0 0 1 0 1 0 0.55

A total of 46 centres registered and agreed to provide information on2 retrospective and 1 1 0 0 1 1 1 1 1 5 1 0.75 prospective corneal transplant activities. A total of 75 contributing surgeons participated in 1 0 0 1 1 4 2 2 1 8 1 1 â&#x20AC;&#x201C; Corneal Transplant 1section. the NTR Participation was on a voluntary basis. 1 to 2003) 1 0 on corneal 0 0 transplant 0 0 activities 0 0were0 collected 1 0to 2 Retrospective data (from 1998 10 7 surgery 81 42in the 70recent 40 past. 57 Prospective 29 59 data 26 (from 277 the 30 Notthe Available identify trend of corneal transplant year 2004) on corneal transplant activities involved gathering information on all cornea transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant Table 2.3.3.5: 2004-2008 Notification Form Suture (FormTechnique, N-cds) which is completed at the time of surgery and gathers 2005 2006 2007 2008form is TOTAL Year on the recipient, 2004 information operative procedure and the donor. The second the ii) (N=138) (N=177) (N=230) (N=933) Corneal Transplant Outcome Form (N=192) (Form O-cds) which (N=196) is completed at the end of 12 Suture Technique No. % No. % No. % No. % No. % No. % months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to Interrupted only 132 96 139 72 124 70 138 70 170 74 703 75 follow-up of theonly patient. Continuous 0 0 0 0 5 3 1 1 6 3 12 1 Combined No data

6 0

4 0

18 35

10 18

18 30

10 17

12 45

6 23

10 44

4 19

64 154

7 17

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CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

2.4 CORNEAL TRANSPLANT OUTCOME 2004-2008 List of Tables Table of Corneal Transplantation andDatabase) Transplant Rate per million Table2.1.1: 2.4.1:Number Stock and Flow - Graft Status (Whole population (pmp), 1998-2008.........................................................................46 Optical Non optical Total Table 2.1.2: Types of Corneal Transplant, 1998-2008.......................................................47 No. % No. % No. % Table 2.2.1: Gender Distribution, 1998-2008....................................................................48 699 71 280 29 979 100 Number registered Table 2.2.2: Ethnic Distribution, 1998-2008......................................................................48 312 159 471 Number followed Total Table 2.2.3: Age Distribution of Corneal Transplant Patients, 197 Recipient 63 126 791998-2008........49 323 69 1 year 67 22 23 14 90 19 Table 2.2.4: Primary Diagnosis, 1998-2008.......................................................................50 2 year 41 13 ..............................................51 6 4 47 10 3 year Table 2.2.5: Indications of Corneal Transplant, 2004-2008 7 2 4.....................................52 3 11 2 Table 2.3.1.1: No of Previous Grafts in4 year Grafted Eye, 2004-2008 Table 2.3.1.2: Ocular Co-morbidity, 2004-2008 ...............................................................52 312 159 471 Graft 2.3.1.3: status Pre-operative Vision, 2004-2008................................................................53 Total Table 249 80 87 55 336 71 -Surviving graft Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 63 20 72 45 135 29 -Failed graft Table 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 699 280 979 Recipient status Total Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 143 20.46 103 36.78 246 25.13 -Recipient with complete follow up Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 3 0.43 1 0.36 4 0.41 -Recipient deaths Table 2.3.3.2: of Combined Surgeries, 2004-2008 .................................................58 156 22.32 54 19.29 210 21.45 -Recipient loss -Types followed Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 234 33.47 58 20.71 292 29.82 -Recipient loss - not followed Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 2004-Graft not yet followed 163 23.32 64 22.86 227 23.19 (Transplant duration less than 1 year) 2008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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2.4.2 Outcome – Graft Survival 2004-2008 2.0 INTRODUCTION Graft survival for both optical and non-optical indications at 12 months was 77.3% but this declined to 63.2% at 36 months (Table 2.4.2.1). The cases were grouped into two Corneal transplantation allows restoration visionand in ii)patients with corneal groups based on thesurgery indication for surgery – i) of Optical Non-Optical. Graft blindness. Corneal transplantation in Malaysia dates back to the 1970’s. Today it is survival was 87% at 12 months in the optical group and 58% in the non-optical group. performed by ophthalmologists in theingovernment private sectors each centre This declined to 71% at 36both months the optical and group and 48% in with the non-optical contributing data towards the National Transplant Registry. group (Table 2.4.2.2). Gender did not influence graft survival (Table 2.4.2.3). Poorer graft survival was observed in children less than 10 years of age (Table 2.4.2.4). The Primary National graft Transplant (NTR) wascause established December failure Registry was the commonest of graftinfailure. Graft 2003. failureThe as acorneal result transplant section of the NTR is a systematic centralised data collection of all optical corneal of infection was present in 26 patients (19%), the indication for surgery was non transplantations performed in the country. in 20 patients with 12 of these patients having infective keratitis with or without perforation as the diagnosis at the time of notification (Table 2.4.2.5). A total of 46 centres registered and agreed to provide information on retrospective and prospective corneal transplant activities. A total of 75 contributing surgeons participated in the NTR – Corneal Transplant section. Participation was on a voluntary basis. Table 2.4.2.1: Graft Survival, 2004-2008 Interval (months)

No.

% success

Retrospective data (from 1998 to 471 2003) on corneal transplant activities were collected to 0 100 12 the trend of corneal transplant 366 surgery in the recent 77.3past. Prospective data 2 (from the identify 148 69.9 year 24 2004) on corneal transplant activities involved gathering information on2 all cornea 36 58 63.2 3 transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant 48 11 50.7 7 Notification Form (Form N-cds) which is completed at the time of surgery and gathers information on the recipient, operative procedure and the donor. The second form is the ii) Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of 12 Figure 2.4.2.1: Graft Survival, 2004-2008 months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to follow-up of the patient. 1.00

Cumulative survival

0.80

0.60

0.40

0.20

0.00 0

24 Duration in months

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Cumulative survival

Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 List of Tables Optical Non-Optical Table 2.1.1: Number of CornealNo. Transplantation Transplant million SE Interval (months) % success and SE No.Rate per % success 0 312 100 159 100 population (pmp), 1998-2008.........................................................................46 12 271 86.8 2 95 58.5 4 Table 2.1.2: Types of Corneal Transplant, 1998-2008.......................................................47 24 1151998-2008....................................................................48 79.1 3 33 51.9 4 Table 2.2.1: Gender Distribution, 36 48 71.2 4 10 47.8 6 Table 2.2.2: Ethnic Distribution, 1998-2008......................................................................48 48 7 51.4 10 4 47.8 6 Table 2.2.3: Age Distribution of Corneal Transplant Recipient Patients, 1998-2008........49 Table 2.2.4: Primary Diagnosis, 1998-2008.......................................................................50 Table 2.2.5: Indications of Corneal Transplant, 2004-2008 ..............................................51 Figure 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 Table 2.3.1.1: No of Previous Grafts in Grafted Eye, 2004-2008 .....................................52 Table 2.3.1.2: Ocular Co-morbidity, 2004-2008 ...............................................................52 1.00 Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 Table 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 0.75 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Optical Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Non-Optical 0.50 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 0.25 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 0.00 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1:0Availability of 12 Data on Post Corneal Transplant Unaided Vision .............67 24 36 48 Duration in months Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

Table 2.4.2.3: Graft Survival by Gender, 2004-2008 2.0 INTRODUCTION Male

Female Interval (months) No. % success SE No. % success SE 0 298 100 173 100 Corneal transplantation surgery allows restoration of vision in patients with corneal 12 228 76.2 2 138 79.1 3 blindness. Corneal transplantation in Malaysia dates back to the 1970â&#x20AC;&#x2122;s. Today it is 24 69.0 3 71.4 4 performed by ophthalmologists both85in the government and private63sectors with each centre 36 36 61.5 4 22 66.3 5 contributing data towards the National9 Transplant 48 56.8Registry.6 2 33.2 17

The National Transplant Registry (NTR) was established in December 2003. The corneal transplant section ofGraft the NTR is by a systematic centralised data collection of all corneal Figure 2.4.2.3: Survival Gender, 2004-2008 transplantations performed in the country. 1.00

Cumulative survival

A total of 46 centres registered and agreed to provide information on retrospective and prospective corneal transplant activities. A total of 75 contributing surgeons participated in the NTR â&#x20AC;&#x201C; Corneal Transplant section. Participation was on a voluntary basis. 0.75

Retrospective data (from 1998 to 2003) on corneal transplant activitiesFemale were collected to identify the trend of corneal transplant surgery in the recent past. Prospective data (from the year 2004) on corneal transplant activities involved gathering information on all cornea transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant Male 0.50 Notification Form (Form N-cds) which is completed at the time of surgery and gathers information on the recipient, operative procedure and the donor. The second form is the ii) Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of 12 months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to follow-up of0.25 the patient.

0.00 0

24 Duration in months

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CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

Cumulative survival

Table 2.4.2.4: Graft Survival by Age, 2004-2008 List of Tables 0-9 10-19 Table 2.1.1: Number of CornealNo. Transplantation Rate per million Interval (months) % success and Transplant SE No. % success SE 0 9 100 21 100 population (pmp), 1998-2008.........................................................................46 12 8 88.9 10 18 85.7 8 Table 2.1.2: Types of Corneal Transplant, 1998-2008.......................................................47 24 44.4 23 14 85.7 8 Table 2.2.1: Gender Distribution,3 1998-2008....................................................................48 36 3 44.4 23 10 85.7 8 Table 2.2.2: Ethnic Distribution, 11998-2008......................................................................48 48 44.4 23 1 . . Table 2.2.3: Age Distribution of Corneal Transplant Recipient Patients, 1998-2008........49 20-39 40 Table 2.2.4: Primary Diagnosis,No. 1998-2008.......................................................................50 Interval (months) % success SE No. % success SE 0 28 Transplant, 100 2004-2008 413 100 Table 2.2.5: Indications of Corneal ..............................................51 12 22 78.6 8 318 76.5 2 Table 2.3.1.1: No of Previous Grafts in Grafted Eye, 2004-2008 .....................................52 24 2.3.1.2: Ocular Co-morbidity, 5 2004-2008 78.6 ...............................................................52 8 126 69.0 3 Table 36 3 78.6 8 44 60.9 4 Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 48 2 78.6 8 9 46.5 8 Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 Table 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 Figure 2.4.2.4: Graft Survival by Age, 2004-2008 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 1.00 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 10-19 years Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 0.75 20-29 years Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 40 years Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 0.50 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 0-9 years Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 0.25 Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.2: Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 0.00

List of Figures

24 Duration in months

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Fifth Report of the Fifth Report of the National Transplant Fifth Report of the Registry 2008 National Transplant Registry 2008 2008 National Transplant Registry

CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

Table 2.4.2.5: Causes of Graft Failure 2.0 INTRODUCTION

Total (N=135)

No.with corneal % Corneal transplantation surgery allows restoration of vision in patients 135 29 Graft Failure blindness. Corneal transplantation in Malaysia dates back to the 1970â&#x20AC;&#x2122;s. Today it is Primary graft failure or Primary Endothelial decompensation 34 25 performed by ophthalmologists both in the government and private sectors with each centre Cause of Failure Recurrence of primary disease 12 9 contributing data towards the National Transplant Registry. Late Endothelial decompensation 23 17 Glaucoma

The National Transplant Registry (NTR) was established in December 2003. Infection 26 The corneal 19 21 transplant section ofGraft the rejection NTR is a systematic centralised data collection28of all corneal Others 31 23 transplantations performed in the country.

No data 7 5 *Each patient may have more than one cause of graft failure A total77of 46 centres registered and agreed to provide information on retrospective and patients had 1 cause prospective corneal transplant activities. A total of 75 contributing surgeons participated in 34 patients had 2 causes the NTR â&#x20AC;&#x201C; Corneal section. Participation was on a voluntary basis. 3 patients had 3Transplant causes 1 patient had 4 causes

Retrospective data (from 1998 to 2003) on corneal transplant activities were collected to identify the trend of corneal transplant surgery in the recent past. Prospective data (from the year 2004) on corneal transplant activities involved gathering information on all cornea transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant Notification Form (Form N-cds) which is completed at the time of surgery and gathers information on the recipient, operative procedure and the donor. The second form is the ii) Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of 12 months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to follow-up of the patient.

Fifth Report of the Fifth Report of the National Transplant Registry 2008 FifthRegistry Report of the National Transplant 2008 National Transplant Registry 2008

CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

2.4.3 Visual Outcome List of Tables Visual outcome of corneal transplants was analysed in cases where post corneal Table 2.1.1: Number Corneal Transplant per million transplant unaided of vision wasTransplantation available. Data and on post cornealRate transplant best corrected population (pmp), 1998-2008.........................................................................46 vision was only available in a limited number of the cases (Table 2.4.3.1). Forty nine Table 2.1.2:ofTypes of Corneal 1998-2008.......................................................47 percent optical and 44%Transplant, of non-optical cases had improved unaided vision after Table 2.2.1: Gender Distribution, 1998-2008....................................................................48 surgery (Table 2.4.3.2). Majority of surviving optical grafts had an unaided vision of Table 2.2.2: Ethnic Distribution, 1998-2008......................................................................48 6/24-6/60, whereas the majority in the non optical group had an unaided vision of less Table Distribution of Corneal Transplant Recipient Patients, 1998-2008........49 than2.2.3: 6/60 Age (Table2.4.3.3) (Figure 2.4.3.3). Table 2.2.4: Primary Diagnosis, 1998-2008.......................................................................50 Table 2.2.5: Indications of Corneal Transplant, 2004-2008 ..............................................51 Table 2.3.1.1: NoAvailability of Previous of Grafts Eye, 2004-2008 Table 2.4.3.1: DatainonGrafted Post Corneal Transplant.....................................52 Unaided Vision Table 2.3.1.2: Ocular Co-morbidity, 2004-2008 ...............................................................52 Unaided Vision (N =979) Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 No. ..............................................54 % Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 Data available 414 42 Table 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 Lost to follow up 524 54 Table 2.3.2.3: Preservation Media, 2004-2008..................................................................56 No data 41 4 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Table 2.3.3.1: Types of Surgeries, 2004-2008...................................................................58 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft Survival by Gender, 2004-2008 ........................................................64 Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 Table 2.4.2.5: Causes of Graft Failure...............................................................................66 Table 2.4.3.1: Availability of Data on Post Corneal Transplant Unaided Vision .............67 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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Fifth Report of the Fifth Report of the National Transplant Fifth Report of the Registry 2008 National Transplant Registry 2008 2008 National Transplant Registry

CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery 2.0 INTRODUCTION Optical Non-optical Reason for graft

(n=283)

(n=131)

No. allows restoration % Corneal transplantation surgery of vision No. in patients with%corneal blindness. transplantation in Malaysia49 dates back to 57the 1970â&#x20AC;&#x2122;s. Today Vision Corneal better 140 44 it is performed ophthalmologists52both in the government and private Visionby same 18 37 sectors with each 28 centre contributing data towards the National Transplant13Registry. Vision worse 36 26 20 Not known*

*Either preTransplant op vision and/or post op(NTR) vision is was not available The National Registry established in December 2003. The corneal transplant section of the NTR is a systematic centralised data collection of all corneal transplantations performed in the country. Figure 2.4.3.2: Unaided Visual Outcome After Corneal Transplant Surgery A total of 46 centresOptical registered and agreed to provide Non-optical information on retrospective and 60 prospective corneal transplant activities. A total of 75 contributing surgeons participated in the NTR â&#x20AC;&#x201C; Corneal Transplant section. Participation was on a voluntary basis.

Percent

50 Retrospective data (from 1998 to 2003) on corneal transplant activities were collected to identify the trend of corneal transplant surgery in the recent past. Prospective data (from the year 2004) on corneal transplant activities involved gathering information on all cornea 40 transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant Notification Form (Form N-cds) which is completed at the time of surgery and gathers information on the recipient, operative procedure and the donor. The second form is the ii) 30 Corneal Transplant Outcome Form (Form O-cds) which is completed at the end of 12 months and annually thereafter. Follow-up only ceases upon failure of graft, death or loss to follow-up of the patient. 20

Vision Better

Vision same Vision

44 68

Vision worse

Not known

Fifth Report of the Fifth Report of the2008 National Transplant Registry FifthRegistry Report of the National Transplant 2008 National Transplant Registry 2008

CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

Cumulative Probability

Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases List of Tables Optical Non Optical Table 2.1.1: Number of Corneal Transplantation and Transplant Rate per million Vision Graft Survival Graft Failure Graft Survival Graft Failure (227) (56) (70) (61) population (pmp), 1998-2008.........................................................................46 No. % No. % No. % No. % Table 2.1.2: Types of Corneal Transplant, 1998-2008.......................................................47 6/18 or better 62 27 0 0 17 24 2 3 Table 2.2.1: Gender Distribution, 1998-2008....................................................................48 6/24 â&#x20AC;&#x201C; 6/60 94 41 3 5 20 29 3 5 Table Ethnic Distribution, 1998-2008......................................................................48 Less2.2.2: than 6/60 69 30 53 95 31 44 56 92 Table 2.2.3: Age Distribution Transplant Data not available 2 of Corneal 1 0 0Recipient 2 Patients, 3 1998-2008........49 0 0 Table 2.2.4: Primary Diagnosis, 1998-2008.......................................................................50 Table 2.2.5: Indications of Corneal Transplant, 2004-2008 ..............................................51 Table 2.3.1.1: No of Previous Grafts in Grafted Eye, 2004-2008 Figure 2.4.3.3: Cumulative Probability for Unaided Vision in.....................................52 Grafts Table 2.3.1.2: Ocular Co-morbidity, 2004-2008 ...............................................................52 Table 2.3.1.3: Pre-operative Vision, 2004-2008................................................................53 1 Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2008 ..............................................54 Table 2.3.2.2: Donor Age Distribution, 2004-2008...........................................................55 Table 2.3.2.3: 0.8 Preservation Media, 2004-2008..................................................................56 Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2008..........................................57 Table 2.3.3.1: 0.6 Types of Surgeries, 2004-2008...................................................................58 Table 2.3.3.2: Types of Combined Surgeries, 2004-2008 .................................................58 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2008..............................................59 Table 2.3.3.4: 0.4 Difference in Trephined Sizes of Recipient and Donor Corneas, 20042008 ................................................................................................................60 Table 2.3.3.5: Suture Technique, 2004-2008.....................................................................60 0.2 Table 2.4.1: Stock and Flow - Graft Status (Whole Database)..........................................61 Table 2.4.2.1: Graft Survival, 2004-2008 ..........................................................................62 Table 2.4.2.2: Graft Survival by Optical and Non-optical Indication, 2004-2008 ............63 Table 2.4.2.3: Graft ........................................................64 6/6Survival 6/12by Gender, 6/24 2004-2008 6/60 4/60 2/60 CF PL Table 2.4.2.4: Graft Survival by Age, 2004-2008 .............................................................65 6/9 6/18 6/36 5/60 3/60 1/60 HM NPL Table 2.4.2.5: Causes of Graft Failure...............................................................................66 UnaidedTransplant Vision Table 2.4.3.1: Availability of Data on Post Corneal Unaided Vision .............67 Table 2.4.3.2: Unaided Visual Outcome After Cornea Transplant Surgery......................68 optical non optical Table 2.4.3.3: Unaided Vision for Optical and Non Optical Cases ...................................69 Table 2.5.1: Post Transplant Complications ......................................................................70 Table 2.5.2: Post Transplant Graft Rejection Types..........................................................70 List of Figures

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Fifth Report of the Fifth Report ofTransplant the of the Registry 2008 National Fifth Report National Transplant Registry 2008 2008 National Transplant Registry

CORNEAL TRANSPLANTATION CORNEAL TRANSPLANTATION

2.5 POST CORNEAL TRANSPLANT COMPLICATIONS 2.0 INTRODUCTION The common complications observed at one year were post-keratoplasty glaucoma, Corneal restoration vision inRejection patients was withseen corneal graft transplantation vascularisation,surgery epithelialallows problems and graftof rejection. in blindness. Corneal transplantation in Malaysia dates back to the 1970â&#x20AC;&#x2122;s. Today it is 11% who were on follow-up (Table 2.5.1). Endothelial rejection is the commonest performed by ophthalmologists graft rejection (Table 2.5.2).both in the government and private sectors with each centre contributing data towards the National Transplant Registry. The Table National Transplant RegistryComplications (NTR) was established in December 2003. The corneal 2.5.1: Post Transplant nd rd transplant section of the NTR is aOne systematic year 2centralised year 3data yearcollection 4th yearof all corneal Total outcome outcome outcome outcome transplantations performed in the country. (N=366)

(N=225) (N=82) (N=46) (N=13) No. % No. % No. % No. % No. %and A total of 46 centres registered and agreed to provide information on retrospective Any complications 147 70 40 19 20 9 4 2 211 62 in prospective corneal transplant activities. A total of 75 contributing surgeons participated Complication Epithelial Problem 37 17 7 9 3 7 2 18 49 14 the NTR â&#x20AC;&#x201C; Corneal Transplant section. Participation was on a voluntary basis. Wound 2 1 0 0 0 0 0 0 2 1 Dehiscence Retrospective dataSuture (from 1998 to infiltration / 2003) on corneal transplant activities were collected to 10 5 2 5 0 0 28 abscess identify the trend of corneal transplant22surgery in 4the recent past. Prospective data (from8 the Endophthalmitis 1 0 involved 1 1 0 0 0 0on all 2 cornea 1 year 2004) on corneal transplant activities gathering information Microbial keratitis 25 12 5 7 2 5 0 0 32 9 transplants performed in Malaysia on two forms. The first form is the i) Corneal Transplant Vascularisation 44 21 8 11 5 12 2 18 59 17 Notification Form (Form N-cds) which is completed at the time of surgery and gathers Post-keratoplasty 59 28 21 28 13 30 2 18 95 28 ii) information on theglaucoma recipient, operative procedure and the donor. The second form is the Corneal Transplant which GraftOutcome Rejection Form 33(Form 15 O-cds) 6 8 0is completed 0 0 at 0the end 39 of 11 12 months and annually thereafter. Follow-up only ceases upon 23 failure53of graft, death or loss No data 67 31 34 46 7 64 131 38 to * Eachof patient may have more than one complication follow-up the patient.

Table 2.5.2: Post Transplant Graft Rejection Types One year 2nd year outcome outcome (N=82) (N=225) No. % No. % Graft Rejection 33 6 Types Epithelial 11 33 2 33 Stromal 11 33 0 0 Endothelial 12 36 3 50 No data 5 15 1 17 * Each patient may have more than one type of rejection

44 70

3rd year outcome (N=46) No. % 0 0 0 0 0 0 0 0 0

4th year outcome (N=13) No. % 0 0 0 0 0 0 0 0 0

Total (N = 366) No. 39 13 11 15 6

% 33 28 38 15

CHAPTER 3 HEART AND LUNG TRANSPLANTATION Editors: Mr Mohamed Ezani Md. Taib Dato’ Dr David Chew Soon Ping Dr Ashari Yunus Expert Panel: Mr Mohamed Ezani Md. Taib (Chairperson) Dr Abdul Rais Sanusi Datuk Dr Aizai Azan Abdul Rahim Dr Ashari Yunus Dato’ Dr David Chew Soon Ping Contents 3.0 Introduction 3.1 Stock and Flow of Heart Transplantation 3.2 Recipients’ Characteristics x Demographics and Clinical Status x Primary Diagnosis 3.3 Transplant Practices x Type of Transplant x Immunosuppressive Therapy and Other Medications x Duration of Waiting Time on the Waiting List 3.4 Transplant Outcomes x Post Transplant Complications x Patient Survival x Causes of Death

HEART HEARTAND ANDLUNG LUNGTRANSPLANTATION TRANSPLANTATION

Fifth Fifth Report of the Fifth Report Report ofof thethe National Transplant Registry 2008 plant plant Registry Registry 2008 2008 National National Trans Trans

List ListofofTables Tables Table Table3.1.1a: 3.1.1a:Stock Stockand andFlow FlowofofHeart HeartTransplantation, Transplantation,1997-2008 1997-2008............................. .............................7474 Table Table3.2.1a: 3.2.1a:Distribution DistributionofofPatients PatientsbybyGender, Gender,1997-2008 1997-2008....................................... .......................................7575 Table Table3.2.2a: 3.2.2a:Distribution DistributionofofPatients PatientsbybyEthnic EthnicGroup, Group,1997-2008 1997-2008............................. .............................7575 Table Table3.2.3a: 3.2.3a:Distribution DistributionofofPatients PatientsbybyAge, Age,1997-2008 1997-2008............................................ ............................................7575 Table Table3.2.4a: 3.2.4a:Distribution DistributionofofPatients PatientsbybyPrimary PrimaryDiagnosis, Diagnosis,1997-2008 1997-2008..................... .....................7575 Table Table3.3.1a: 3.3.1a:Distribution DistributionofofPatients PatientsbybyHeart HeartProcedure, Procedure,1997-2008 1997-2008......................... .........................7676 Table Table3.3.2a: 3.3.2a:Distribution DistributionofofPatients PatientsbybyImmunosuppressive ImmunosuppressiveUsed, Used,1997-2008.......... 1997-2008..........7676 Table Table3.3.3a: 3.3.3a:Immunosuppressive ImmunosuppressiveUsed UsedatatTime TimeofofLast LastFollow-up Follow-upupuptoto2008 2008........... ...........7676 Table Table3.3.4a: 3.3.4a:Duration DurationofofWaiting WaitingTime TimeononWaiting WaitingList, List,1997-2008 1997-2008.......................... ..........................7777 Table Table3.4.1a: 3.4.1a:Post PostTransplant TransplantEvents EventsatatLast LastFollow-up Follow-upupuptoto2008 2008............................. .............................7878 Table Table3.4.2a: 3.4.2a:Post PostTransplant TransplantMalignancies MalignanciesatatFollow-up Follow-upupuptoto2008 2008.......................... ..........................7878 Table Table3.4.3a: 3.4.3a:Non-compliance Non-complianceatatFollow-up Follow-upupuptoto2008 2008............................................... ...............................................7979 Table Table3.4.4a: 3.4.4a:Patient PatientTreated Treatedfor forRejection RejectionatatFollow-up Follow-upupuptoto2008............................ 2008............................7979 Table Table3.4.5a: 3.4.5a:Distribution DistributionofofPatients PatientsbybyTime TimeofofDeaths, Deaths,1997-2008 1997-2008.......................... ..........................7979 Table Table3.4.6a: 3.4.6a:Patient PatientSurvival, Survival,1997-2008..................................................................... 1997-2008.....................................................................8080 Table Table3.4.7a: 3.4.7a:Cause CauseofofDeath DeathatatDischarge, Discharge,1997-2008................................................. 1997-2008.................................................8181 Table Table3.4.8a: 3.4.8a:Cause CauseofofDeath DeathatatFollow-up, Follow-up,1997-2008 1997-2008................................................ ................................................8181 Table Table3.1.1b: 3.1.1b:Stock Stockand andFlow FlowofofLung LungTransplantation, Transplantation,2005-2008…………………..82 2005-2008…………………..82 Table Table3.2.1b: 3.2.1b:Distribution DistributionofofPatients PatientsbybyGender, Gender,2005-2008…………………………83 2005-2008…………………………83 Table Table3.2.2b: 3.2.2b:Distribution DistributionofofPatients PatientsbybyEthnic EthnicGroup, Group,2005-2008…………………..83 2005-2008…………………..83 Table Table3.2.3b: 3.2.3b:Distribution DistributionofofPatients PatientsbybyAge, Age,2005-2008…………………………….83 2005-2008…………………………….83 Table Table3.2.4b: 3.2.4b:Distribution DistributionofofPatients PatientsbybyPrimary PrimaryDiagnosis, Diagnosis,2005 2005-2008…………….83 -2008…………….83 Table Table3.3.1b: 3.3.1b:Distribution DistributionofofPatients PatientsbybyLung LungProcedure, Procedure,2005-2008………………..84 2005-2008………………..84 Table Table3.3.3b: 3.3.3b:Immunosuppressive ImmunosuppressiveUsed UsedatatTime TimeFollow-up Follow-uptoto2008………………….84 2008………………….84 Table Table3.4.5b: 3.4.5b:Distribution Distributionofofpatients patientsbybytime timeofofdeaths, deaths,2005-2008………………….84 2005-2008………………….84 List ListofofFigures Figures Figure Figure3.1.1a: 3.1.1a:Stock Stockand andFlow FlowofofHeart HeartTransplantation, Transplantation,1997-2008............................ 1997-2008............................7474 Figure Figure3.4.6a: 3.4.6a:Patient PatientSurvival, Survival,1997-2008……………………………………………80 1997-2008……………………………………………80 Figure Figure3.1.1b: 3.1.1b:Stock Stockand andFlow FlowofofLung LungTransplant Transplantand andHeart HeartLung LungTransplant……....82 Transplant……....82

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3.0 INTRODUCTION Following the introduction of heart transplant in 1997 and lung transplant in 2005, the number of thoracic organ transplants has been few and far between. The main limitation to the performance of heart and lung transplants has been the lack of success in obtaining viable donor thoracic organs. Because of the infrequent performance of thoracic organ transplants results would not be expected to improve. In 2008, no thoracic organ transplants were conducted. For end stage heart failure patients, a new approach to keep the patients alive while awaiting transplant has been explored with the use of ventricular assist devices as a bridge to transplant. 2 patients reached their 10th anniversary following their transplants in 1998. The rest of the report that follows will review the results of heart and lung transplantation in Malaysia till end of 2008.

Fifth Fifth Report of the Report ofof thethe Fifth Report National Transplant Registry 2008 plant Registry 2008 National Trans plant Registry 2008 National Trans

HEART HEARTAND ANDLUNG LUNGTRANSPLANTATION TRANSPLANTATION

Number of patients

3.1 STOCK AND FLOW List of Tables Table 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008 ............................. 74 Table and Flow Heart Transplantation, 1997-2008 Table3.1.1a: 3.2.1a:Stock Distribution ofof Patients by Gender, 1997-2008 ....................................... 75 Year 1997 1998 1999 2000 2001 2002 2003 2004 2006 2007 75 2008 Table 3.2.2a: Distribution of Patients by Ethnic Group, 1997-20082005 ............................. New transplant Table 3.2.3a: Distribution of Patients by Age, 1997-2008 ............................................ 75 1 3 2 3 4 0 2 0 1 1 1 0 patients Table 3.2.4a: Distribution of Patients by Primary Diagnosis, 1997-2008 ..................... 75 Deaths 0 1 0 3 1 3 1 0 0 1 0 0 Table 3.3.1a: Distribution of0Patients Procedure, 760 Retransplanted 0 0 0 by Heart 0 0 0 1997-2008 0 0 ......................... 0 1 Table 3.3.2a: Distribution of Patients by Immunosuppressive Used, 1997-2008.......... 76 Lost to follow 0 0 0 0 0 0 0 0 0 0 0 0 upTable 3.3.3a: Immunosuppressive Used at Time of Last Follow-up up to 2008 ........... 76 st Alive at 31 Table 3.3.4a: Duration Time on List, 778 1 3 of Waiting 5 5 8 Waiting 5 6 1997-2008 6 7.......................... 7 8 December Table 3.4.1a: Post Transplant Events at Last Follow-up up to 2008 ............................. 78 Note: The same patient was re-transplanted in the year 2007, thus only counted as one. Table 3.4.2a: Post Transplant Malignancies at Follow-up up to 2008 .......................... 78 Table 3.4.3a: Non-compliance at Follow-up up to 2008 ............................................... 79 Table 3.4.4a: Patient Treated for Rejection at Follow-up up to 2008............................ 79 Figure and Flow of Heartby Transplantation, 1997-2008 Table3.1.1a: 3.4.5a:Stock Distribution of Patients Time of Deaths, 1997-2008 .......................... 79 New transplant patients Alive at 31st December Table 3.4.6a: Patient Survival, 1997-2008..................................................................... 80 9 Table 3.4.7a: Cause of Death at Discharge, 1997-2008................................................. 81 Table 3.4.8a: Cause of Death at Follow-up, 1997-2008 ................................................ 81 8 Table 3.1.1b: Stock and Flow of Lung Transplantation, 2005-2008…………………..82 Table 3.2.1b: Distribution of Patients by Gender, 2005-2008…………………………83 7 Table 3.2.2b: Distribution of Patients by Ethnic Group, 2005-2008…………………..83 6 Table 3.2.3b: Distribution of Patients by Age, 2005-2008…………………………….83 Table 3.2.4b: Distribution of Patients by Primary Diagnosis, 2005 -2008…………….83 5 Table 3.3.1b: Distribution of Patients by Lung Procedure, 2005-2008………………..84 Table 3.3.3b: Immunosuppressive Used at Time Follow-up to 2008………………….84 4 Table 3.4.5b: Distribution of patients by time of deaths, 2005-2008………………….84 3

List of Figures 2 Figure 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008............................ 74 1 Figure 3.4.6a: Patient Survival, 1997-2008……………………………………………80 Figure 3.1.1b: Stock and Flow of Lung Transplant and Heart Lung Transplant……....82 0

1997

1998

1999

2000

2001

2002

Year

7472

2003

2004

2005

2006

2007

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3.0 RECIPIENTSâ&#x20AC;&#x2122; INTRODUCTION 3.2 CHARACTERISTICS Following theDistribution introductionofofPatients heart transplant in 1997-2008 1997 and lung transplant in 2005, the Table 3.2.1a: by Gender, Year 97 98 99 00 01 02 03 06 between. 07 08 TheTOTAL number of thoracic organ transplants has been 04few 05 and far main Gender No. No. No. No. No. No. No. No. No. No. No. No. No. limitation to the performance of heart and lung transplants has been the lack of success Male 1 3 0 2 2 0 2 0 1 1 0 0 12 in obtaining0 viable thoracic Because Female 0 donor 2 1 2 organs. 0 0 0 of the 0 infrequent 0 1 performance 0 6 of TOTAL 1 transplants 3 2 results 3 4 0 be2expected 0 1 1 0 18 thoracic organ would not to1 improve. Note: The same patient was re-transplanted in the year 2007, thus only counted as one.

In 2008, no thoracic organ transplants were conducted. For end stage heart failure Table 3.2.2a: Distribution of keep Patients Ethnicalive Group, 1997-2008 patients, a new approach to the by patients while awaiting transplant has been Year 97 98 99 00 01 02 03 04 05 06 07 08 TOTAL explored with No. the use of ventricular assist devices as a bridge to transplant. Ethnic group No. No. No. No. No. No. No. No. No. No. No. No. Malay Chinese 2 patients Indian TOTAL

5 3 10 18

1 1

3 3

1 2

1 3

2 4

0 0

1 2

0 0

0 1

1 1

0 1

0 0

05 No. 1 0 0 0 1 15 15 15 15

06 No. 0 0 1 0 1 44 44 44 44

07 No. 1 0 0 0 1 15 15 15 15

08 No. 0 0 0 0 0 -

TOTAL No. 6 2 10 0 18 35 16 40 13 55

th 0 their 0 100 anniversary 1 0 following 0 1 their 0 transplants 0 0 in 1998. 1 0 reached

The rest of the report that follows will review the results of heart and lung Note: The same patient was re-transplanted in the year 2007, thus only counted as one. transplantation in Malaysia till end of 2008. Table 3.2.3a: Distribution of Patients by Age, 1997-2008 Year Age, years 0-19 20-39 40-59 Â&#x2022;60 TOTAL Mean SD Median Minimum Maximum

97 No. 0 0 1 0 1 51 51 51 51

98 No. 0 2 1 0 3 40 9 37 33 50

99 No. 2 0 0 0 2 16 1 16 15 16

00 No. 1 0 2 0 3 37 22 44 13 55

01 No. 1 0 3 0 4 38 17 43 14 54

02 No. 0 0 0 0 0 -

03 No. 0 0 2 0 2 46 8 46 40 52

04 No. 0 0 0 0 0 -

Age=date of transplant-date of birth Note: The same patient was re-transplanted in the year 2007, thus only counted as one. Age for 2007 patient was same for 1st and 2nd transplant

Table 3.2.4a: Distribution of Patients by Primary Diagnosis, 1997-2008 Year Primary diagnosis Ischaemic Cardiomyopathy Idiopathic Dilated Cardiomyopathy Restrictive Cardiomyopathy End Stage Valvular Heart Disease Hypertrophic Cardiomyopathy Others TOTAL

97 No.

98 No.

99 No.

00 No.

01 No.

02 No.

03 No.

04 No.

05 No.

06 No.

07 No.

08 No.

TOTAL No.

0 1

0 3

0 2

0 3

0 4

0 0

0 2

0 0

0 1

1 1

0 0

1 18

Note: The same patient was re-transplanted in the year 2007, thus only counted as one.

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3.3 TRANSPLANT PRACTICES List of Tables Table 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008 ............................. 74 Table Procedure, 1997-2008 Table3.3.1a: 3.2.1a:Distribution DistributionofofPatients PatientsbybyHeart Gender, 1997-2008 ....................................... 75 Year 97 98 99 00 01 02 03 04 05 06 ............................. 07 08 TOTAL Table 3.2.2a: Distribution of Patients by Ethnic Group, 1997-2008 75 Heart Table 3.2.3a: Distribution of Patients by Age, 1997-2008 ............................................ No. No. No. No. No. No. No. No. No. No. No. No. No. 75 Procedure Table 3.2.4a: Distribution of Patients by Primary Diagnosis, 1997-2008 ..................... 75 Orthotopic 1 1 0 Patients 0 0by Heart 0 0 0 0 0 0......................... 0 2 76 Table 3.3.1a: Distribution of Procedure, 1997-2008 Bicaval Table 3.3.2a: Distribution of Patients by Immunosuppressive Used, 1997-2008.......... 76 Orthotopic 0 2 2 3 4 0 2 0 1 1 2 0 17 Table 3.3.3a: Immunosuppressive Used at Time of Last Follow-up up to 2008 ........... 76 Traditional Heterotopic 0 0 of Waiting 0 0 Time 0 on0 Waiting 0 0 0 0 0 0 0 77 Table 3.3.4a: Duration List, 1997-2008 .......................... TOTAL 1 3 2 3 4 0 2 0 1 1 2 0 19 Table 3.4.1a: Post Transplant Events at Last Follow-up up to 2008 ............................. 78 Table 3.4.2a: Post Transplant Malignancies at Follow-up up to 2008 .......................... 78 Table of Patients by Immunosuppressive Used, 1997-2008 Table3.3.2a: 3.4.3a:Distribution Non-compliance at Follow-up up to 2008 ............................................... 79 Year 97 98 99 00 01 02 03 04 06 07 08 Total Table 3.4.4a: Patient Treated for Rejection at Follow-up up to052008............................ 79 Type of No. No. No. No. No. No. No. No. No. No. No. No. No. Table 3.4.5a: Distribution of Patients by Time of Deaths, 1997-2008 .......................... 79 immunosuppressive Table 3.4.6a: Patient Survival, 1997-2008..................................................................... 80 Steroids Table 3.4.7a: Cause1of Death at Prednisolone 3 2 Discharge, 3 4 1997-2008................................................. 0 1 0 1 0 1 0 1681 Methylprednisolone 3 2 Follow-up, 3 4 1997-2008 0 2 ................................................ 0 1 1 2 0 1981 Table 3.4.8a: Cause1of Death at Calcineurin Table 3.1.1b: Stock and Flow of Lung Transplantation, 2005-2008…………………..82 Inhibitors Table 3.2.1b: Distribution of Patients by Gender, 2005-2008…………………………83 Cyclosporin A 0 0 0 0 0 0 1 0 0 1 0 0 2 Table 3.2.2b: Distribution of Patients by 4Ethnic Group, 2005-2008…………………..83 Neoral® 1 3 2 3 0 0 0 1 0 0 0 14 Table 3.2.3b: Distribution Tacrolimus (FK506) 0 0 of Patients 0 0 by 0Age, 02005-2008…………………………….83 0 0 0 0 1 0 1 Table 3.2.4b: Distribution of Patients by Primary Diagnosis, 2005 -2008…………….83 Antimetabolites Table 3.3.1b: Distribution Azathioprine (AZA) 1 3 of Patients 2 3 by 4Lung0Procedure, 2 0 2005-2008………………..84 0 1 0 0 16 Mycophenolate Table 3.3.3b: Immunosuppressive Used at Time Follow-up to 2008………………….84 0 0 0 0 1 0 0 0 1 0 1 0 3 Mofetil Table(MMF) 3.4.5b: Distribution of patients by time of deaths, 2005-2008………………….84 Anti-lymphocyte Receptor Antibodies List of Figures Anti-thymocyte 0 0 0 0 0 0 0 0 0 0 2 0 2 globulin Figure(ATG) 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008............................ 74 TOTAL Figurepatients 3.4.6a:atPatient 1 Survival, 3 2 1997-2008……………………………………………80 3 4 0 2 0 1 1 2 0 19 notification Figure 3.1.1b: Stock and Flow of Lung Transplant and Heart Lung Transplant……....82

Table 3.3.3a: Immunosuppressive Used at Time of Last Follow-up up to 2008 Year of follow up* 2004 2005 Type of immunosuppressive No. No. Steroids Prednisolone 1 3 Methylprednisolone 0 0 Calcineurin Inhibitors Cyclosporin A Neoral® 1 6 Tacrolimus (FK506) Antimetabolites Azathioprine (AZA) 1 3 Mycophenolate Mofetil (MMF) 3 3 TOTAL patients at follow-up 6 6 *Data according to year of follow up of transplanted patients

76 72

2006 No.

2007 No.

2008 No.

2 0

7 1

2 5 7

1 4 7

1 6 8

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Table 3.3.4a: Duration of Waiting Time on Waiting List, 1997-2008 3.0 INTRODUCTION

Year 97 98 99 00 01 02 03 04 05 06 07 08 TOTAL Duration Following the introduction transplant in 1997 in 2005, No. No. No.of heart No. No. No. No. No. and No.lung No.transplant No. No. No.the (months)* number of thoracic organ transplants has been few and far between. The main <5 0 2 1 0 1 0 1 0 0 0 0 0 5 limitation to the1performance of0heart1 and 0lung 0transplants has been the lack of success 0 1 0 1 0 0 0 4 5 10 in obtaining viable donor organs. 0 0 0thoracic 1 0 0 Because 0 0of the 0 infrequent 1 2 performance 0 4 of 10 15 thoracic organ transplants results 0 0 0 1 would 0 not0 be expected 0 0 to0improve. 0 0 0 1 15 20 0 0 0 0 0 0 0 0 0 0 0 0 0 20 25 In 2008, no thoracic were conducted. heart failure 0 0 organ 0 transplants 0 0 0 0 0 0For 0end stage 0 0 0 25 30 0 0 keep 0 the0patients 0 0 0 0awaiting 0 0 0 has been 0 30 35 patients, a new 0approach to alive while transplant 0 0 0 0 0 0 1 0 0 0 0 0 1 35 40 explored with the use of ventricular assist devices as a bridge to transplant. TOTAL 1 2 2 2 2 0 2 0 1 1 2 0 15 Mean 6 2 15 5 20 9 10 9 following their transplants in131998.2 patients reached their 10th4 anniversary SD 0 1 6 5 25 0 9 Median 6 2 4 15 5 20 9 10 13 8 The rest of the that follows review Minimum 6 report 2 3 10 1 will 2 - the 9 results 10 of 13 heart- and lung 1 transplantation in Maximum 6 Malaysia 2 5till end 19 of82008.37 9 10 13 37 *Duration=date of transplant-date added to wait list

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Fifth Fifth Report of the Fifth Report Report ofof thethe National Transplant Registry 2008 plant plant Registry Registry 2008 2008 National National Trans Trans

3.4 List TRANSPLANT of Tables OUTCOMES Table 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008 ............................. 74 Table Table3.4.1a: 3.2.1a:Post Distribution Transplant ofEvents Patientsatby Last Gender, Follow-up 1997-2008 up to 2008 ....................................... 75 Year of Table 3.2.2a: Distribution of Patients Group, 75 97 98 99 00 01by Ethnic 02 03 04 1997-2008 05 06 ............................. 07 08 TOTAL transplant* Table 3.2.3a: Distribution of Patients by Age, 1997-2008 ............................................ 75 Type of post Table 3.2.4a: Distribution of Patients by Primary Diagnosis, 1997-2008 ..................... 75 transplant No. No. No. No. No. No. No. No. No. No. No. No. No. Table 3.3.1a: Distribution of Patients by Heart Procedure, 1997-2008 ......................... 76 events Table 3.3.2a: Distribution of Patients by Immunosuppressive Used, 1997-2008.......... 76 Drug Treated 1 2 2 1 3 0 1 0 0 0 0 0 10 Hypertension Table 3.3.3a: Immunosuppressive Used at Time of Last Follow-up up to 2008 ........... 76 Bone Disease Table 3.3.4a: Duration List, 1997-2008 .......................... 1 0 of Waiting 0 0 Time 1 on0 Waiting 0 0 0 0 0 0 2 77 (Symptomatic) Table 3.4.1a: Post Transplant Events at Last Follow-up up to 2008 ............................. 78 Chronic Liver 0 Transplant 0 0 Malignancies 0 0 0 at Follow-up 0 0 0 to 2008 0 0 0 0 78 Table 3.4.2a: Post up .......................... Disease Table 3.4.3a: Non-compliance at0 Follow-up Cataracts 0 0 0 0 0 up to 0 2008 0 ............................................... 0 0 0 0 0 79 Table 3.4.4a: Patient Treated for Rejection at Follow-up up to 2008............................ Diabetes 1 2 0 0 0 0 1 0 0 0 0 0 4 79 Renal Table 3.4.5a: Distribution of Patients by Time of0 Deaths, 1997-2008 .......................... 79 1 1 0 0 1 0 0 0 0 0 0 3 Dysfunction Table 3.4.6a: Patient Survival, 1997-2008..................................................................... 80 Stroke 0 0 Death 0 at 0Discharge, 0 0 1997-2008................................................. 0 0 0 0 0 0 0 81 Table 3.4.7a: Cause of Drug-Treated 1 2 Death 2 at 1Follow-up, 3 0 1997-2008 1 0 ................................................ 1 0 0 0 11 81 Table 3.4.8a: Cause of Hyperlipidaemia Table 3.1.1b: Stock and Flow of Lung Transplantation, 2005-2008…………………..82 TOTAL Table at 3.2.1b: Distribution 1 2 2of Patients 1 3by Gender, 0 1 2005-2008…………………………83 0 1 0 1 0 12 patients follow-up Table 3.2.2b: Distribution of Patients by Ethnic Group, 2005-2008…………………..83 *Data according year of transplant of patientby Age, 2005-2008…………………………….83 Table 3.2.3b:toDistribution of Patients Table 3.2.4b: Distribution of Patients by Primary Diagnosis, 2005 -2008…………….83 Table Transplant at Follow-up up2005-2008………………..84 to 2008 Table3.4.2a: 3.3.1b:Post Distribution ofMalignancies Patients by Lung Procedure, Year of Table 3.3.3b: Immunosuppressive Used01at Time 97 98 99 00 02 Follow-up 03 04 to 052008………………….84 06 07 08 TOTAL transplant* Table 3.4.5b: Distribution of patients by time of deaths, 2005-2008………………….84 Type of post transplant No. No. No. No. No. No. No. No. No. No. No. No. No. malignancies Recurrence of preList of Figures 0 0 0 0 0 0 0 0 0 0 0 0 0 transplant tumour Stock and Flow of Heart Transplantation, 1997-2008............................ 74 Figure 3.1.1a: De Novo solid Figure 3.4.6a: Patient 1 Survival, 0 0 1997-2008……………………………………………80 0 0 0 0 0 0 0 0 0 1 tumour Figure 3.1.1b: Stock and Flow of Lung Transplant and Heart Lung Transplant……....82 De Novo 0 0 0 0 0 0 0 0 0 0 0 0 0 lymphoproliferative disorder Skin 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL patients 1 2 2 1 3 0 1 0 1 0 1 0 12 at follow-up *Data according to year of transplant of patient

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HEART AND LUNG TRANSPLANTATION

Table 3.4.3a: Non-compliance at Follow-up up to 2008 3.0 INTRODUCTION

Year of transplant* 97 98 99 00 01 02 03 04 05 06 07 08 TOTAL Non-compliance Following the introduction of heart 1997No. and No. lung No. transplant in 2005, No. No. No. transplant No. No. inNo. No. No. No. the No. during follow-up number of thoracic organ transplants has been few and far between. The main 0 0 2 0 0 0 1 0 0 0 0 0 3 x Yes limitation to the performance of heart and lung transplants has been the lack of success 1 2 0 1 3 0 0 0 1 0 1 0 9 x No in obtaining viable donor thoracic organs. Because of the infrequent performance of TOTAL patients at 1 results 2 2 1 not be 3 expected 0 1 to improve. 0 1 0 1 0 12 thoracic organ transplants would follow-up Areas of noncompliance: In 2008, no thoracic organ transplants were conducted. For end stage heart failure x Immunosuppression patients, a new approach 0 to 0keep 1the patients 0 0 alive 0 while 1 awaiting 0 0 transplant 0 0 has0 been 2 medication explored with the use of ventricular assist devices as a bridge to transplant. x Patient unable to afford 0 0 0 following 0 0 their0transplants 0 0 in 1998. 0 0 0 0 2 patients reached their010th anniversary immunosuppression medications 0 that 0 follows 0 0 will0 review 0 0the results 0 0 of 0heart0 and0 lung 0 x TheOther restmedication of the report x Other therapeutic transplantation in Malaysia till 0 0 end 1 of 2008. 0 0 0 0 0 0 0 0 0 1 regimen TOTAL patients with 0 0 2 0 0 0 1 0 0 0 0 0 3 noncompliance *Data according to year of transplant of patient

Table 3.4.4a: Patient Treated for Rejection at Follow-up up to 2008 Year of 97 98 99 00 01 transplant* Patient treated No. No. No. No. No. for rejection 0 1 1 0 1 x Yes 1 1 1 1 2 x No TOTAL patients at 1 2 2 1 3 follow-up Number of rejection events 0 1 0 0 1 x1 0 0 0 0 0 x2 0 0 1 0 0 x3 TOTAL 0 1 1 0 1 patients with rejection *Data according to year of transplant of patient

TOTAL

No.

0 0

0 1

0 0

1 0

0 0

0 1

0 0

4 8

0 0 0

1 0 0

0 0 0

3 0 1

Table 3.4.5a: Distribution of Patients by Time of Deaths, 1997-2008 Year of discharge 97 98 99 Time of deaths* No. No. No. <3 months (at 0 0 1 discharge) 3-<6 months 0 0 0 6 months-1 year 0 0 0 >1 year 0 0 0 TOTAL patients who 0 1 0 died *Time=Date of death窶電ate of transplant

00 No.

01 No.

02 No.

03 No.

04 No.

05 No.

06 No.

07 No.

TOTAL No.

0 0 1

0 1 1

0 0 0

0 1 3

7973

Fifth Fifth Report of the Report ofof thethe Fifth Report National Transplant Registry 2008 plant Registry 2008 National Trans plant Registry 2008 National Trans

HEART HEARTAND ANDLUNG LUNGTRANSPLANTATION TRANSPLANTATION

Cumulative survival

Table 3.4.6a: Patient Survival, 1997-2008 List of Tables Year of Transplant 1997-2008 Table 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008 ............................. 74 Interval % Survival SE Table 3.2.1a: Distribution of Patients by Gender, 1997-2008 ....................................... 75 6 months 68 11 Table 3.2.2a: Distribution of Patients by Ethnic Group, 1997-2008 ............................. 75 1 year 63 11 Table 3.2.3a: Distribution of Patients by Age, 1997-2008 ............................................ 75 2 year 50 12 by Primary Diagnosis, 1997-2008 ..................... 75 3 Table year 3.2.4a: Distribution of Patients 44 12 by Heart Procedure, 4 Table year 3.3.1a: Distribution of Patients 44 12 1997-2008 ......................... 76 5 Table year 3.3.2a: Distribution of Patients 44 12 by Immunosuppressive Used, 1997-2008.......... 76 6 Table year 3.3.3a: Immunosuppressive 44 Used at Time of Last 12 Follow-up up to 2008 ........... 76 7 Table year 3.3.4a: Duration of Waiting 44 Time on Waiting List, 12 1997-2008 .......................... 77 8 year 44 12 Table 3.4.1a: Post Transplant Events at Last Follow-up up to 2008 ............................. 78 9 year 44 12 Table 3.4.2a: Post Transplant Malignancies at Follow-up 10 year 44 12 up to 2008 .......................... 78 Table 3.4.3a: SE=standard errorNon-compliance at Follow-up up to 2008 ............................................... 79 Table 3.4.4a: Patient Treated for Rejection at Follow-up up to 2008............................ 79 Duration = date follow up-date transplant, if alive at discharge = date of discharge-date of transplant, if alive to follow up Table 3.4.5a: Distribution of Patients by Timebutoflost Deaths, 1997-2008 .......................... 79 = date of discharge-date of transplant, if dead at discharge Table 3.4.6a: Patient Survival, 1997-2008..................................................................... 80 Table 3.4.7a: Cause of Death at Discharge, 1997-2008................................................. 81 Table 3.4.8a: Cause of Death at Follow-up, 1997-2008 ................................................ 81 Figure Survival, 1997-2008 Table3.4.6a: 3.1.1b:Patient Stock and Flow of Lung Transplantation, 2005-2008…………………..82 Table 3.2.1b: Distribution of Patients by Gender, 2005-2008…………………………83 Kaplan-Meier survival estimate Table 3.2.2b: Distribution of Patients by Ethnic Group, 2005-2008…………………..83 Table 3.2.3b: Distribution of Patients by Age, 2005-2008…………………………….83 1.003.2.4b: Distribution of Patients by Primary Diagnosis, 2005 -2008…………….83 Table Table 3.3.1b: Distribution of Patients by Lung Procedure, 2005-2008………………..84 Table 3.3.3b: Immunosuppressive Used at Time Follow-up to 2008………………….84 Table 0.753.4.5b: Distribution of patients by time of deaths, 2005-2008………………….84 List of Figures 0.50 Figure 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008............................ 74 Figure 3.4.6a: Patient Survival, 1997-2008……………………………………………80 Figure 3.1.1b: Stock and Flow of Lung Transplant and Heart Lung Transplant……....82 0.25

0.00 0 .5 1

Duration in years

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Table 3.4.7a: Cause of Death at Discharge, 1997-2008 3.0 INTRODUCTION

Year 97 98 99 00 01 02 03 04 05 06 07 08 TOTAL Cause of death No. No. No. No. No. No. No. No. No. No. No. No. No.the Following the introduction of heart transplant in 1997 and lung transplant in 2005, Hyperacute number of thoracic organ 0 0 0transplants 0 0 has0 been 1 few 0 and 0 far0 between. 0 0 The main 1 rejection limitation to the performance of heart and lung transplants has been the lack of success Multi organ 0 donor 0 0 1 organs. 0 0Because 0 0 0 performance 0 1 of in obtaining viable thoracic of0 the 0infrequent failure thoracic organ transplants results would not be expected to improve. Respiratory 0 0 0 0 0 1 0 0 0 0 0 0 1 failure secondary to septicaemia In 2008, no thoracic organ transplants were conducted. For end stage heart failure Respiratory patients, a new approach to keep the patients alive while awaiting transplant has been failure, renal explored with the use of ventricular assist devices as a bridge to transplant. function and 0 0 0 1 0 0 0 0 0 0 0 0 1 liver failure, th ARDS, 2 patients reached their 10 anniversary following their transplants in 1998. septicaemia Septicaemia, The rest of the report that follows will review the results of heart and lung multiorgan 0 1 0 0 0 0 0 0 0 0 0 0 1 transplantation in Malaysia till end of 2008. failure Graft failure 0 0 0 0 0 0 0 0 0 1 0 0 1 TOTAL patients who 0 1 0 2 0 1 1 0 0 1 0 0 6 died at discharge

Table 3.4.8a: Cause of Death at Follow-up, 1997-2008 Year Cause of death Severe bleeding Lung cancer, small cell type, septicaemia, bronchopneumonia Rejection due to non-compliance Unknown TOTAL patients who died at follow-up

97 No. 0

98 No. 0

99 No. 0

00 No. 0

01 No. 0

02 No. 1

03 No. 0

04 No. 0

05 No. 0

06 No. 0

07 No. 0

08 No. 0

TOTAL No. 1

8173

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Fifth Fifth Report of the Report ofof thethe Fifth Report National Transplant Registry 2008 plant Registry 2008 National Trans plant Registry 2008 National Trans

Number of patients

LUNG & HEART-LUNG TRANSPLANTATION List ofTRANSPLANTATION Tables Table 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008 ............................. 74 Table 3.2.1a: Distribution 3.1 STOCK AND FLOW of Patients by Gender, 1997-2008 ....................................... 75 Table 3.2.2a: Distribution of Patients by Ethnic Group, 1997-2008 ............................. 75 Table and Flow Lung Transplantation, 2005-2008 Table3.1.1b: 3.2.3a:Stock Distribution of of Patients by Age, 1997-2008 ............................................ 75 Year 2005 2006 2007 2008 Table 3.2.4a: Distribution of Patients by Primary Diagnosis, 1997-2008 ..................... 75 New transplant patients 1 1 2 0 Table 3.3.1a: Distribution of Patients by Heart Procedure, 1997-2008 ......................... 76 Deaths 0 1 1 0 Table 3.3.2a: Distribution of Patients by Immunosuppressive Used, 1997-2008.......... 76 Retransplanted 0 0 0 0 Table 3.3.3a:upImmunosuppressive Used at Time up to 2008 ........... 76 Lost to follow 0 0 of Last Follow-up 0 0 st Table 3.3.4a: Duration of Waiting Time on Waiting List, 1997-2008 .......................... 77 Alive at 31 December 1 1 2 2 Table 3.4.1a: Post Transplant Events at Last Follow-up up to 2008 ............................. 78 Table 3.4.2a: Post Transplant Malignancies at Follow-up up to 2008 .......................... 78 Table3.1.1b: 3.4.3a: Stock Non-compliance Follow-up up toand 2008 ............................................... 79 Figure and Flow ofatLung Transplant Heart Lung Transplant Table 3.4.4a: Patient Treated for Rejection at Follow-up up to 2008............................ 79 Table 3.4.5a: Distribution of Patients by Time of Deaths, 1997-2008 .......................... 79 New transplant patients Table 3.4.6a: Patient Survival, 1997-2008..................................................................... 80 Alive at 31st Dec Table 3.4.7a: Cause of Death at Discharge, 1997-2008................................................. 81 Table 3.4.8a: Cause of Death at Follow-up, 1997-2008 ................................................ 81 Table 3.1.1b: Stock and Flow of Lung Transplantation, 2005-2008…………………..82 Table 3.2.1b: Distribution of Patients by Gender, 2005-2008…………………………83 Table 3.2.2b: Distribution of Patients by Ethnic Group, 2005-2008…………………..83 4 Table 3.2.3b: Distribution of Patients by Age, 2005-2008…………………………….83 Table 3.2.4b: Distribution of Patients by Primary Diagnosis, 2005 -2008…………….83 Table 3.3.1b: Distribution of Patients by Lung Procedure, 2005-2008………………..84 Table 3.3.3b: Immunosuppressive Used at Time Follow-up to 2008………………….84 Table 3.4.5b: Distribution of patients by time of deaths, 2005-2008………………….84 2 List of Figures Figure 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008............................ 74 Figure 3.4.6a: Patient Survival, 1997-2008……………………………………………80 0 Figure 3.1.1b: Stock Lung Transplant2007 and Heart Lung2008 Transplant……....82 2005and Flow of 2006

Year

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HEART AND LUNG TRANSPLANTATION

3.0 RECIPIENTâ&#x20AC;&#x2122;S INTRODUCTION 3.2 CHARACTERISTICS Following theDistribution introductionofofPatients heart transplant in 2005-2008 1997 and lung transplant in 2005, the Table 3.2.1b: by Gender, Year 2005 2006 number of thoracic organ transplants has been2007 few and far 2008 between. The main Gender No. No. No. limitation to the performance of heart and lung transplants has beenNo. the lack of success Male 1 1 0 performance of in obtaining viable donor thoracic organs. Because1 of the infrequent Female 0 0 1 0 thoracic organ transplants results would not be expected to improve. 0 TOTAL 1 1 2 In 2008, no thoracic organ transplants were conducted. For end stage heart failure patients, a new approach to the by patients while awaiting transplant has been Table 3.2.2b: Distribution of keep Patients Ethnicalive Group, 2005-2008 explored of ventricular2006 assist devices as a bridge to transplant. Year with the use 2005 2007 2008 Race No. No. No. No. th 2Malay patients reached their 0 10 anniversary 0 following their 1 transplants in 0 1998. Chinese 0 0 0 0 Indian 1 1 0 0 The rest of the report that follows will review the results of heart and lung Iban 0 1 0 transplantation in Malaysia till end of0 2008. TOTAL 1 1 2 0

Table 3.2.3b: Distribution of Patients by Age, 2005-2008 Year Age(years) 0-19 20-39 40-59 Â&#x2022; 60 TOTAL

2005 No. 0 0 1 0 1

2006 No. 0 1 0 0 1

2007 No. 1 1 0 0 2

2008 No. 0 0 0 0 0

Table 3.2.4b: Distribution of Patients by Primary Diagnosis, 2005 -2008 Year Diagnosis Idiopathic pulmonary fibrosis Idiopathic pulmonary arterial hypertension Chronic obstructive pulmonary disease Bronchiectasis TOTAL

2005 No. 1 0 0 0 1

8373

2006 No. 1 0 0 0 1

2007 No. 1 1 0 0 2

2008 No. 0 0 0 0 0

HEART HEARTAND ANDLUNG LUNGTRANSPLANTATION TRANSPLANTATION

Fifth Fifth Report of the Fifth Report Report ofof thethe National Transplant Registry 2008 plant plant Registry Registry 2008 2008 National National Trans Trans

3.3 List TRANSPLANT’S of Tables PRACTISES Table 3.1.1a: Stock and Flow of Heart Transplantation, 1997-2008 ............................. 74 Table Table3.3.1b: 3.2.1a:Distribution DistributionofofPatients PatientsbybyLung Gender, Procedure, 1997-2008 2005-2008 ....................................... 75 Year 2005 2006 2008 2008 Table 3.2.2a: Distribution of Patients by Ethnic Group, 1997-2008 ............................. 75 Procedure No. No. No. No. Table 3.2.3a: Distribution of Patients by Age, 1997-2008 ............................................ 75 Single Lung Transplant 1 0 0 0 Table 3.2.4a: Distribution of Patients by Primary Diagnosis, 1997-2008 ..................... 75 Double Lung Transplant 0 1 1 0 Table 3.3.1a: Distribution of Patients by Heart0 Procedure, 1997-2008 ......................... 76 Heart – Lung Transplant 0 1 0 Table 3.3.2a: Distribution of Patients by Immunosuppressive Used, 1997-2008.......... 76 TOTAL 1 1 2 0 Table 3.3.3a: Immunosuppressive Used at Time of Last Follow-up up to 2008 ........... 76 Table3.3.3b: 3.3.4a:Immunosuppressive Duration of WaitingUsed Timeaton Waiting List, 1997-2008 Table Time Follow-up to 2008 .......................... 77 Table 3.4.1a: Post Transplant Events up2007 to 2008 ............................. 78 Year 2005at Last Follow-up 2006 2008 Table 3.4.2a: Post Transplant Malignancies atNo. Follow-up up 78 Immunosuppresive drugs No. No.to 2008 .......................... No. Steroids: Table 3.4.3a: Non-compliance at Follow-up up to 2008 ............................................... 79 Prednisolone 1 2 1 Table 3.4.4a: Patient Treated for Rejection at Follow-up up2to 2008............................ 79 Methylprednisolone 1 1 2 0 Table 3.4.5a: Distribution of Patients by Time of Deaths, 1997-2008 .......................... 79 Antimetabolites: Table 3.4.6a: Patient Survival, 1997-2008..................................................................... 80 Azathioprine(AZA) 0 0 0 0 Table 3.4.7a: Cause of Death at Discharge, 1997-2008................................................. 81 Mycophenolate (MMF) 1 2 3 2 Neoral 1 2 3 0 Table 3.4.8a: Cause of Death at Follow-up, 1997-2008 ................................................ 81 Tacrolimus 0 Transplantation, 0 0 2 Table 3.1.1b: Stock and Flow of Lung 2005-2008…………………..82 TOTAL patients Distribution at follow -up of Patients 1 by Gender, 2 2005-2008…………………………83 3 2 Table 3.2.1b: Table 3.2.2b: Distribution of Patients by Ethnic Group, 2005-2008…………………..83 Table 3.2.3b: Distribution of Patients by Age, 2005-2008…………………………….83 3.4 TRANSPLANT’S OUTCOMES Table 3.2.4b: Distribution of Patients by Primary Diagnosis, 2005 -2008…………….83 Table 3.3.1b: Distribution of Patients by Lung Procedure, 2005-2008………………..84 Table of patientsUsed by time of deaths, 2005-2008 Table3.4.5b: 3.3.3b:Distribution Immunosuppressive at Time Follow-up to 2008………………….84 Year 2005 2006 2007 2008 Table 3.4.5b: Distribution of patients by time of deaths, 2005-2008………………….84 Death No. No. No. No. < 3 months 0 1 1 0 3 - < 6 months 0 0 0 0 of Figures 6 List – 12 months 0 0 0 0 > Figure 12 months 0 0 0 3.1.1a: Stock and Flow of0Heart Transplantation, 1997-2008............................ 74 TOTAL 0 1 1 0 Figure 3.4.6a: Patient Survival, 1997-2008……………………………………………80

Figure 3.1.1b: Stock and Flow of Lung Transplant and Heart Lung Transplant……....82

84 72

CHAPTER 4 LIVER TRANSPLANTATION Editor: 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

Contents 4.0 Introduction 4.1 Stock and Flow of Liver Transplantation 4.2 Recipientsâ&#x20AC;&#x2122; Characteristics x Demographics x Primary Diagnosis 4.3 Transplant Practices x Type of Transplant x Immunosuppressive Therapy 4.4 Transplant Outcomes x Patient Survival x Causes of Death

Fifth Report of the National Transplant Registry Fifth Report of the Fifth Report of the2008 National Transplant National Transplant RegistryRegistry 2008 2008

LIVER TRANSPLANTATION LIVER TRANSPLANTATION

List of Tables List of Tables Table 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008..........................................87 Table 4.1.1 Stock andof Flow of Liver Transplantation, 1993-2008..........................................87 Table 4.1.2 Distribution Patients by Place of Transplant, 1993-2008.................................88 Table 4.1.2 Distribution of Patients Placefor of Transplant, 1993-2008.................................88 Table 4.1.3 Distribution of Patients by by Centres Liver Transplantation, 1993-2008..........88 Table 4.1.3 Distribution of Patients Centres for Liver Transplantation, 1993-2008..........88 Table 4.2.1 Distribution of Patients by by Gender, 1993-2008....................................................89 Table 4.2.1 Distribution of Patients Gender, 1993-2008....................................................89 Table 4.2.2 Distribution of Patients by by Ethnic Group, 1993-2008..........................................90 Table 4.2.2 Distribution of Patients Ethnic Group, 1993-2008..........................................90 Table 4.2.3 Distribution of Patients by by Age, 1993-2008.........................................................91 Table 4.2.3 Distribution of Patients by Age, 1993-2008.........................................................91 Table 4.2.4 Primary Diagnosis, 1993-2008 (N=100)...............................................................92 Table 4.2.4 Primaryfor Diagnosis, 1993-2008 (N=100)...............................................................92 Table 4.2.5 Indication Transplantation, 1993-2008 (N=100).............................................92 Table 4.2.5 Indication for Transplantation, 1993-2008 (N=100).............................................92 Table 4.2.6 Recipients’ Blood Group, 1993-2008 ..................................................................93 Table 4.2.6 Recipients’ Group, 1993-2008 ..................................................................93 Table 4.3.1 Distribution of Blood Patients by Type of Donors, 1993-2008.......................................94 Table 4.3.1 Distribution of Patients by Type of Donors, 1993-2008.......................................94 Table 4.3.2 Immunosuppresive Drug Treatment at Transplantation, 1993-2008 (N=100).....94 Table 4.3.2 Immunosuppresive Drug Treatment at1993-2008 Transplantation, 1993-2008 (N=100).....94 Table 4.4.1 Patient Survival by Year of Transplant, (N=100)...............................95 Table 4.4.1 Patient Survival by Year of Transplant, 1993-2008 (N=100)...............................95 Table 4.4.2 Patient Survival by Gender, 1993-2008 (N=100).................................................96 Table 4.4.2 Patient Survival Gender, Table 4.4.3 Patient Survival by by Age Group,1993-2008 1993-2008(N=100).................................................96 (N=100)...........................................97 Table 4.4.3 Patient Survival by Age Group,of1993-2008 (N=100)...........................................97 Table 4.4.4 Distribution of Patients by Cause Death, 1993-2008 (N=100)........................98 Table 4.4.4 Distribution of Patients by Cause of Death, 1993-2008 (N=100)........................98 List of Figures List of Figures Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008.........................................87 Figure 4.1.1 Stock andof Flow of Liver Transplantation, 1993-2008.........................................87 Figure 4.2.1 Distribution Patients by Gender, 1993-2008...................................................89 Figure 4.2.1 Distribution of Patients by Gender, 1993-2008...................................................89 Figure 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008.........................................90 Figure 4.2.2 Distribution Ethnic Group, 1993-2008.........................................90 Figure 4.4.1 Patient SurvivalofbyPatients Year ofby Transplant, 1993-2008............................................95 Figure 4.4.1 Patient Survival Year of Transplant, 1993-2008............................................95 Figure 4.4.2 Patient Survival by by Gender, 1993-2008..............................................................96 Figure 4.4.2 Patient Survival Gender, Figure 4.4.3 Patient Survival by by Age Group,1993-2008..............................................................96 1993-2008........................................................97 Figure 4.4.3 Patient Survival by Age Group, 1993-2008........................................................97

Fifth Report of the National Registry 2008 Fifth Report of the of the Fifth Transplant Report National Transplant Registry 2008 2008 National Transplant Registry

LIVER TRANSPLANTATION LIVER TRANSPLANTATION

4.1 STOCK AND FLOW 4.1 STOCK AND FLOW The number of liver transplants performed from 1993 to 2008 is one hundred. Eighty six The(86%) number of performed liver transplants from 1993were to 2008 is oneathundred. were locally performed and fourteen (14%) performed overseas Eighty centres.six Five (86%) were performed locally and fourteen (14%) were performed at overseas centres. Five new liver transplants were done in 2008 and they were all done locally at Selayang Hospital. new liver transplants were done in 2008 and they were all done locally at Selayang Hospital. Table 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008 Table 4.1.1 Stock and Flow 1993-2008 Year 93 of94Liver 95 Transplantation, 96 97* 98 99 00 01 02 03** 04 05 06 07 08

Year New transplant patients93 194 195 896 1397* 3 98 299 800 301 502 1003** 5 04 NewDeaths transplant patients 1 0 1 0 8 313 4 3 1 2 1 8 4 3 1 5 210 5 5 1 16 Deaths 0 00 03 04 0 1 0 1 04 01 02 05 0 1 0 5 Re-Transplant Re-Transplant 0 00 00 00 0 0 0 0 00 00 10 00 1 0 0 0 Lost to follow up LostFunctioning to follow upgraft at 0 0 0 0 0 0 0 1 0 1 0 0 1 2 7 16 18 19 23 24 27 31 35 31st December Functioning graft at 1 2 7 16 18 19 23 24 27 31 35 46 patient who was alive until 05/12/1997 is recorded dead with missing date of death 31st*1 December ** 1 patient transplanted 2003 is recorded as dead with missing datedate of death *1 patient who was alive untilin05/12/1997 is recorded dead with missing of death ** 1 patient transplanted in 2003 is recorded as dead with missing date of death

1605 55 06 00 1 46 44

506 68 03 10 0 44 49

807 37 02 00 0 49 54

708 25 02 00 0 54 57

5 2 0 0

Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008 Figure 4.1.1 Stock and of Liver Transplantation, 1993-2008 NewFlow patients Alive at 31st Dec 60 55

Number of patients (n) Number of patients (n)

50 45 40 35 30 25 20 15 10 5 0

Alive at 31st Dec

New patients

55 50 45 40 35 30 25 20 15 10 5 0

1993 1995 1997 1999 2001 2003 2005 2007 1994 1996 1998 2000 2002 2004 2006 2008 1993 1995 1997 1999 2001 2003 2005 2007 Year 1998 2000 2002 2004 2008 1994 1996 2006

Year

Fifth Report of the National Transplant Registry Fifth Report of the Fifth Report of the2008 National Transplant National Transplant RegistryRegistry 2008 2008

LIVER TRANSPLANTATION LIVER TRANSPLANTATION

Table Distribution of Patients by Place of Transplant, 1993-2008 List4.1.2 of Tables Year (No.)

Place of Transplant

Table 4.1.1 Stock 93 and 94 Flow95of 96 Liver97Transplantation, 98 99 00 011993-2008..........................................87 02 03 04 05 06 07 08 TOTAL Table 4.1.2 Distribution Local 0 0 of 8Patients 10 1by Place 1 8of Transplant, 3 5 9 1993-2008.................................88 2 14 5 8 7 5 86 Table 4.1.3 Distribution Overseas 1 1 of 0Patients 3 2by Centres 1 0 for 0 Liver 0 Transplantation, 1 3 2 0 1993-2008..........88 0 0 0 14 TOTAL 1 1 of 8Patients 13 3by Gender, 2 8 1993-2008....................................................89 3 5 10 5 16 5 8 7 5 100 Table 4.2.1 Distribution Table 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008..........................................90 Table 4.2.3 Distribution of Patients by Age, 1993-2008.........................................................91 Table 4.1.3 Distribution of Patients1993-2008 by Centres(N=100)...............................................................92 for Liver Transplantation, 1993-2008 Table 4.2.4 Primary Diagnosis, Table 4.2.5 Indication for Transplantation, 1993-2008 (N=100).............................................92 Year (No.) Transplant Centre Table 4.2.6 Recipientsâ&#x20AC;&#x2122; 1993-2008 93 Blood 94 95Group, 96 97 98 99 ..................................................................93 00 01 02 03 04 05 06 07 08 TOTAL Sime Darby Medical Table 4.3.1 Distribution 0 of 0 Patients 8 10by 1Type 1 of 8Donors, 3 51993-2008.......................................94 6 2 7 0 0 0 0 51 Centre, Subang Jaya Table 4.3.2 Immunosuppresive Drug Treatment at Transplantation, 1993-2008 (N=100).....94 0 0 by 0 Year 0 of0 Transplant, 0 0 01993-2008 0 3 (N=100)...............................95 0 7 5 8 7 5 35 Hospital Table Selayang 4.4.1 Patient Survival University of Malaya Table 4.4.2 Patient Survival 0 0 by 0 Gender, 0 0 1993-2008 0 0 0(N=100).................................................96 0 0 0 0 0 0 0 0 0 Medical Centre Table 4.4.3 Patient Survival by Age Group, 1993-2008 (N=100)...........................................97 Royal Children's 0 of 0 Patients 0 2 by 1Cause 0 of0 Death, 0 1993-2008 0 0 0 (N=100)........................98 0 0 0 0 0 3 Table 4.4.4 Distribution Hospital, Brisbane National University 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 Hospital, Singapore Queensland Liver List of Figures 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 2 Transplant Service, Australia Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008.........................................87 Kings College Hospital, 0 1 Patients 0 0 by0 Gender, 0 0 1993-2008...................................................89 0 0 0 0 0 0 0 0 0 1 Figure 4.2.1 Distribution of UK 0 0 Patients 0 0 by0 Ethnic 0 Group, 0 0 1993-2008.........................................90 0 0 1 1 0 0 0 0 2 FigureChina 4.2.2 Distribution of Tianjin, Asian Centre for Liver Figure 4.4.1 Patient Survival by Year of Transplant, 1993-2008............................................95 Disease & 4.4.2 Patient Survival by Gender, 1993-2008..............................................................96 Figure 0 0 0 0 0 0 0 0 0 1 2 1 4 Transplantation, Figure 4.4.3 Patient Survival by Age Group, 1993-2008........................................................97 Singapore 1 1 8 13 3 2 8 3 5 10 5 16 5 8 7 5 100 TOTAL

Fifth Report of the National Registry 2008 Fifth Report of the of the Fifth Transplant Report National Transplant Registry 2008 2008 National Transplant Registry

LIVER TRANSPLANTATION LIVER TRANSPLANTATION

4.2 RECIPIENTSâ&#x20AC;&#x2122; CHARACTERISTICS 4.1 STOCK AND FLOW Fifty four (54%) were males and 46 (46%) were females. The ethnic distribution of the liver Thetransplant number of liver transplants performed from511993 to 2008 is one hundred. Eighty8 six recipients are as follows: Chinese (51%), Malays 39 (39%), Indians (8%), (86%) were performed locally and fourteen (14%) were performed at overseas centres. Five Others 2 (2%). new liver transplants were done in 2008 and they were all done locally at Selayang Hospital. Eighty (80%) of the transplant recipients were between 1 and 9 years of age at the time of transplantation. Biliary atresia was the primary liver disease in 72 (72%) of the recipients. Table Stock andindication Flow of Liver 1993-2008 The4.1.1 commonest for Transplantation, liver transplantation was failure to thrive with growth retardation and poor93liver amongst Year 94 function. 95 96 The 97* commonest 98 99 00blood 01 group 02 03** 04 the 05 liver 06 transplant 07 08 was group1 O (38%). Newrecipients transplant patients 1 8 13 3 2 8 3 5 10 5 16 5 8 7 5

Deaths 0 0 3 4 1 1 4 1 2 5 1 5 6 Re-Transplant 0 0 0 0 0 0 0 0 0 0 0 0 0 Table 4.2.1 Distribution of Patients by Gender, 1993-2008 Lost to follow up 0 0 0 0 0 0 0 1(No.)0 1 0 0 1 Year Gender Functioning graft93at 94 95 96 97 98 99 00 01 02 03 04 05 06 07 1 2 7 16 18 19 23 24 27 31 35 46 44 31stMale December 0 0 6 5 2 1 3 1 2 7 5 10 2 6 3 *1 patient date Femalewho was 1 alive 1 until 2 05/12/1997 8 1 is recorded 1 5 dead 2 with 3 missing 3 0 of6 death3 2 4 ** 1 patient transplanted in 2003 is recorded as dead with missing date of death TOTAL 1 1 8 13 3 2 8 3 5 10 5 16 5 8 7

3 0 0 4908 1 4 5

2 0 0

2 0 0 TOTAL 54 57 54 46 100

Figure 4.2.1 Distribution by Gender, 1993-2008 Figure 4.1.1 Stock and Flowof ofPatients Liver Transplantation, 1993-2008 60

Male New patients

Female Alive at 31st Dec

Number of patients (n) Number of patients (n)

50 8 45 40 35

30 25 4 20 15 2 10 5 0

0 1993 1995 1997 1999 2001 2003 2005 2007 1993 1995 1997 1999 2001 2003 2005 2007 1994 1996 1998 2000 2002 2004 2006 2008 1998 2000 2002 2004 2008 1994 1996 2006 Year

Year

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LIVER TRANSPLANTATION LIVER TRANSPLANTATION

Table 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008 List of Tables Year (No.) Ethnic group

93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 TOTAL Malay 0 1 and2 Flow 3 of1Liver 0 Transplantation, 4 1 2 3 1993-2008..........................................87 1 11 3 3 2 2 39 Table 4.1.1 Stock Chinese 1 0 6 8 2 1 2 2 3 6 4 5 1 3 4 3 51 Table 4.1.2 Distribution of Patients by Place of Transplant, 1993-2008.................................88 Indian 0 0 0 of2 Patients 0 1 by Centres 1 0 for 0 Liver 0 0 0 1 2 1993-2008..........88 1 0 8 Table 4.1.3 Distribution Transplantation, Others 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 2 Table 4.2.1 Distribution of Patients by Gender, 1993-2008....................................................89 TOTAL 1 1 8 of 13 Patients 3 2 by Ethnic 8 3 Group, 5 101993-2008..........................................90 5 16 5 8 7 5 100 Table 4.2.2 Distribution

Number of patients (n)

Table 4.2.3 Distribution of Patients by Age, 1993-2008.........................................................91 Table 4.2.4 Primary Diagnosis, 1993-2008 (N=100)...............................................................92 Figure 4.2.2 Distribution by Ethnic1993-2008 Group, 1993-2008 Table 4.2.5 Indication of forPatients Transplantation, (N=100).............................................92 Malay Chinese Table 4.2.6 Recipientsâ&#x20AC;&#x2122; Blood Group, 1993-2008 ..................................................................93 Indian Others Table 4.3.1 Distribution of Patients by Type of Donors, 1993-2008.......................................94 12 Table 4.3.2 Immunosuppresive Drug Treatment at Transplantation, 1993-2008 (N=100).....94 Table 4.4.1 Patient Survival by Year of Transplant, 1993-2008 (N=100)...............................95 Table 4.4.2 Patient Survival by Gender, 1993-2008 (N=100).................................................96 10 Table 4.4.3 Patient Survival by Age Group, 1993-2008 (N=100)...........................................97 Table 4.4.4 Distribution of Patients by Cause of Death, 1993-2008 (N=100)........................98 8

List of Figures 6

Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008.........................................87 Figure 4.2.1 Distribution of Patients by Gender, 1993-2008...................................................89 4 Figure 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008.........................................90 Figure 4.4.1 Patient Survival by Year of Transplant, 1993-2008............................................95 Figure 4.4.2 Patient Survival by Gender, 1993-2008..............................................................96 2 Figure 4.4.3 Patient Survival by Age Group, 1993-2008........................................................97 0

1993

1994

1995

1996

1997

1998

1999

Year

2000

2001

2002

2003

2004

2005

2006

2007

2008

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LIVER TRANSPLANTATION LIVER TRANSPLANTATION

Table 4.2.3 Distribution of Patients by Age, 1993-2008 Year (No.) 4.1Age STOCK AND FLOW Group*

TOTAL

0 0 0 0 04 0 16 5 5 4 0 3 0 5 146 8

1 0 2 0 05 0 5 8 6 12 0 15 1 4 2 44 39

1 0 1 0 06 0 8 7 3 10 0 13 0 5 2 49 37

0 5 0 2 3 8 0 3 07 08 0 2 7 5 5 100 2 2 17 9 0 0 10 14 0 0 23 3 54 57 2 3 months 26 74

The<1number 0of liver performed 1993 to0 20080 is one six1 0 0transplants 0 0 1 0 from 0 0 0 0hundred. 0 0 Eighty 0 1-4 were performed 1 1 3 locally 11 3 and fourteen 1 5 (14%) 3 4were performed 5 2 9 overseas 2 4 centres. 3 1 Five 58 (86%) at 0 0 3 1 done 0 in 2008 0 0 were 1 all 3done locally 1 3 at 3Selayang 1 2 Hospital. 1 21 new5-9liver transplants were and2 they

10-14 0 0 1 1 0 0 0 0 0 0 0 1 15-19 0 0 0 0 0 0 1 0 0 0 0 1 20-39 0 0and1Flow 0 of0Liver 0Transplantation, 0 0 0 1993-2008 1 0 0 Table 4.1.1 Stock 40-59 0 0 0 0 0 0 0 0 0 1 1 1 Year 93 94 95 96 97* 98 99 00 01 02 03** Â&#x2022;60 0 0 0 0 0 0 0 0 0 0 1 1 New transplant patients 1 1 8 13 3 2 8 3 5 10 5 TOTAL 1 1 8 13 3 2 8 3 5 10 5 16 Deaths 0 0 3 4 1 1 4 1 2 5 1 Mean 2 4 9 4 2 1 4 1 2 10 27 12 Re-Transplant 0 0 0 0 0 0 0 0 0 0 0 SD 9 4 1 1 5 0 2 14 33 22 Lost to follow up 0 0 0 0 0 0 0 1 0 1 0 Median 2 4 5 2 2 1 2 1 2 4 9 3 Functioning graft at 16 18 1 191 231 24 27 311 35 4 2 1 2 2 1 7 3 months 4 months 1 31stMinimum December 2 Maximum 2 4 30 14 2 1 15 2 5 46 73 74 *1 patient who was alive until 05/12/1997 is recorded dead with missing date of death

Age=date if transplant â&#x20AC;&#x201C; dateis of birth as dead with missing date of death ** 1* patient transplanted in 2003 recorded

Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008 Alive at 31st Dec

New patients 60 55

Number of patients (n)

50 45 40 35 30 25 20 15 10 5 0

1993

1994

1995

1996

1997

1998

1999

Year

2000

2001

2002

2003

2004

2005

2006

2007

2008

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LIVER TRANSPLANTATION LIVER TRANSPLANTATION

List of Tables Table 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008..........................................87 Table 4.1.2 Distribution of Patients by Place of Transplant, 1993-2008.................................88 Table 4.1.3 Distribution of Patients by Centres for Liver Transplantation, 1993-2008..........88 Table 4.2.1 Distribution of Patients by Gender, 1993-2008....................................................89 Table 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008..........................................90 Table 4.2.3 Distribution of Patients by Age, 1993-2008.........................................................91 Table 4.2.4 Primary Diagnosis, 1993-2008 (N=100)...............................................................92 Table 4.2.5 Indication for Transplantation, 1993-2008 (N=100).............................................92 Table 4.2.6 Recipientsâ&#x20AC;&#x2122; Blood Group, 1993-2008 ..................................................................93 Table 4.3.1 Distribution of Patients by Type of Donors, 1993-2008.......................................94 Table 4.3.2 Immunosuppresive Drug Treatment at Transplantation, 1993-2008 (N=100).....94 Table 4.4.1 Patient Survival by Year of Transplant, 1993-2008 (N=100)...............................95 Table 4.4.2 Patient Survival by Gender, 1993-2008 (N=100).................................................96 Table 4.4.3 Patient Survival by Age Group, 1993-2008 (N=100)...........................................97 Table 4.4.4 Distribution of Patients by Cause of Death, 1993-2008 (N=100)........................98 List of Figures Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008.........................................87 Figure 4.2.1 Distribution of Patients by Gender, 1993-2008...................................................89 Figure 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008.........................................90 Figure 4.4.1 Patient Survival by Year of Transplant, 1993-2008............................................95 Figure 4.4.2 Patient Survival by Gender, 1993-2008..............................................................96 Figure 4.4.3 Patient Survival by Age Group, 1993-2008........................................................97

92 86

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LIVER TRANSPLANTATION LIVER TRANSPLANTATION

Table 4.2.6 Recipientsâ&#x20AC;&#x2122; Blood Group, 1993-2008 4.1 STOCK AND FLOW Year (No.) Blood group

TOTAL

O 0 0 2 5 1 0 3 3 3 5 1 8 No Data 1 0 3 5 2 0 0 0 0 1 3 2 TOTAL 2 8 3 51993-2008 10 5 16 Table 4.1.1 Stock1and 1Flow8 of 13 Liver3 Transplantation,

2 0 5

1 0 8

2 0 7

2 1 5

38 18 100

TheA number of liver six 0 1transplants 2 0 performed 0 0 3from 0 1993 1 to 3 2008 1 is4 one1 hundred. 4 2 Eighty 1 23 (86%) B were performed 0 0 locally 1 2and 0fourteen 1 2(14%) 0 were 1 performed 1 0 1 at overseas 1 3 3centres. 1 Five 17 0 were 0 0done1 in 2008 0 1and 0they0were0 all 0done0locally 1 at 1 Selayang 0 0 Hospital. 0 4 newABliver transplants

Year 93 94 95 96 97* 98 99 00 01 02 03** New transplant patients 1 1 8 13 3 2 8 3 5 10 5 Deaths 0 0 3 4 1 1 4 1 2 5 1 Re-Transplant 0 0 0 0 0 0 0 0 0 0 0 Lost to follow up 0 0 0 0 0 0 0 1 0 1 0 Functioning graft at 1 2 7 16 18 19 23 24 27 31 35 31st December *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

04 16 5 0 0

05 5 6 0 1

06 8 3 0 0

07 7 2 0 0

08 5 2 0 0

Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008 Alive at 31st Dec

New patients 60 55

Number of patients (n)

50 45 40 35 30 25 20 15 10 5 0

1993

1994

1995

1996

1997

1998

1999

Year

2000

2001

2002

2003

2004

2005

2006

2007

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LIVER TRANSPLANTATION LIVER TRANSPLANTATION

4.3 TRANSPLANT PRACTICES List of Tables Seventy five (75%) of liver transplants were living donors while twenty five (25%) were Table 4.1.1 Stock and62% Flowofofliving Liverdonors Transplantation, from cadaveric donors. were first 1993-2008..........................................87 degree relatives with mother to child Table Patients by Place of Transplant, 1993-2008.................................88 being the4.1.2 mostDistribution common. of The immunosuppressive medications most commonly used are Table 4.1.3 Distribution of Patients by Centres for Liver Transplantation, 1993-2008..........88 tacrolimus and steroids. Table 4.2.1 Distribution of Patients by Gender, 1993-2008....................................................89 Table 4.2.2 Distribution of Patients Ethnic Group,1993-2008 1993-2008..........................................90 Table 4.3.1 Distribution of Patients by by Type of Donors, Table 4.2.3 Distribution of Patients by Age, 1993-2008.........................................................91 Year (No.) Table 4.2.4 Primary Diagnosis, 1993-2008 (N=100)...............................................................92 Type of donor Table 4.2.5 Indication Transplantation, 93 94for 95 96 97 98 1993-2008 99 00 01(N=100).............................................92 02 03 04 05 06 07 08 TOTAL Table 4.2.6 Recipientsâ&#x20AC;&#x2122; Blood Group, 1993-2008 ..................................................................93 Cadaveric 1 0 of0Patients 3 1by Type 0 0of Donors, 0 0 1993-2008.......................................94 1 1 4 2 4 4 4 25 Table 4.3.1 Distribution Table 4.3.2-Immunosuppresive Drug Treatment at Transplantation, 1993-2008 (N=100).....94 Living Related 0 1 5 2 1 2 5 2 2 2 2 7 1 1 0 0 33 Mother Table 4.4.1 Patient Survival by Year of Transplant, 1993-2008 (N=100)...............................95 Living Related Table 4.4.2-Patient 0 Survival 0 2 by7Gender, 1 01993-2008 2 0 (N=100).................................................96 2 3 0 1 1 3 3 1 26 Father Table 4.4.3 Patient Survival by Age Group, 1993-2008 (N=100)...........................................97 Living Related 0 0 of0Patients 0 0by Cause 0 0 of Death, 0 0 1993-2008 0 0 0(N=100)........................98 0 0 0 0 0 Table 4.4.4 Distribution Daughter Living Related 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 2 Son Living List Related of Figures 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 Brother Living Related Figure 4.1.1- Stock0 and0 Flow 0 of0Liver 0 Transplantation, 0 0 0 0 1993-2008.........................................87 0 0 0 0 0 0 0 0 Sister Figure 4.2.1 Distribution of Patients by Gender, 1993-2008...................................................89 Living Related 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Figure 4.2.2 Monozygotic twinDistribution of Patients by Ethnic Group, 1993-2008.........................................90 Figure 4.4.1- Patient Survival by Year of Transplant, 1993-2008............................................95 Living Related 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Dizygotic twin Figure 4.4.2 Patient Survival by Gender, 1993-2008..............................................................96 Living Related Figure 4.4.3- Patient 0 Survival 0 0 by0 Age 0 Group, 0 01993-2008........................................................97 0 0 0 0 0 1 0 0 0 1 Others Living Related 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 Emotionally Living Unrelated

TOTAL patients

100

Table 4.3.2 Immunosuppresive Drug Treatment at Transplantation, 1993-2008 (N=100) Year (No.) Immunosuppressive drugs 93 94 95 96 97 98 99 00 01 02 03 04 Steroids 0 0 2 5 0 2 5 2 5 5 1 12 Azathioprine 0 0 0 0 0 0 0 0 0 0 0 4 Cyclosporin A 1 1 1 2 0 0 0 1 0 0 0 0 Tacrolimus (FK506) 0 0 3 7 2 2 8 2 5 9 5 12 Mycophenolate Mofetil 0 0 0 0 0 0 0 0 0 0 0 0 (MMF) Rapamycin 0 0 0 0 0 0 0 0 0 1 2 0 Monoclonal/Polyclonal 0 0 0 0 0 0 0 0 0 0 0 0 Antiodies Anti IL26 Antibodies 0 0 0 0 0 0 0 0 0 0 0 0 Others 0 0 0 0 0 0 0 0 0 0 0 0 No Data 0 0 4 3 1 0 0 0 0 1 0 4 TOTAL patients 1 1 8 13 3 2 8 3 5 10 5 16 Note: 22 patients had 1 type if drug, 41 patients had 2 types, 23 patients had 3 types

05 5 5 0 5

06 8 8 0 8

07 6 4 0 5

08 5 2 0 4

TOTAL 63 23 6 77

0 0 0 5

0 0 0 8

0 0 1 7

0 0 0 5

0 0 14 100

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LIVER TRANSPLANTATION LIVER TRANSPLANTATION

4.4 TRANSPLANT OUTCOMES 4.1 STOCK AND FLOW The 1 year survival rate for the period 1993 - 1998 and 1999 - 2007 was 71% and 69% Therespectively. number of The livermost transplants from was 1993sepsis. to 2008 is one hundred. Eighty six commonperformed cause of death (86%) were performed locally and fourteen (14%) were performed at overseas centres. Five newTable liver4.4.1 transplants doneby in Year 2008 of and they were 1993-2008 all done locally at Selayang Hospital. Patientwere Survival Transplant, (N=100)

Year of transplant 1993-1998 1999-2008 Table 4.1.1 Stock and Flow of%Liver Transplantation, Survival SE 1993-2008% Survival 1 82 Year 93 94 95 8296 97* 98 997 00 01 02 03** 04 05 6 71 9 70 New transplant patients 1 1 8 13 3 2 8 3 5 10 5 16 5 12 Deaths 0 0 3 71 4 1 1 49 1 2 5 691 5 6 Interval (months)

0 0

0 1

08 5 2 0 0 57

1.00

Re-Transplant 0 0 0 0 0 0 0 0 0 0 0 Lost to follow up 0 0 0 0 0 0 0 1 0 1 0 Functioning graft atPatient Survival by Year of Transplant, 1993-2008 Figure 4.4.1 1 2 7 16 18 19 23 24 27 31 35 31st December *1 patient who was alive until 05/12/1997 is recorded with missing date of death Patient Survival bydead Transplant Year ** 1 patient transplanted in 2003 is recorded as dead with missing date of death

SE 5 07 06 85 7 36 2 0 0 0 0

0.75

Alive at 31st Dec

New patients

0.50

55 50

0.25

45 40 35 30

0.00

Number of patients (n) Cumulative Survival

Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008

25 20

6 8 Duration in months

Year 1993-1998

Year 1999-2008

10 5 0

1993

1994

1995

1996

1997

1998

1999

Year

2000

2001

2002

2003

2004

2005

2006

2007

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LIVER TRANSPLANTATION LIVER TRANSPLANTATION

Table 4.4.2 Patient Survival by Gender, 1993-2008 (N=100) List of Tables Gender Interval (months)

Male

Female

0.75

0.50

Cumulative Survival

1.00

% Survival SE % Survival SE Table 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008..........................................87 1 83 5 80 6 Table 4.1.2 Distribution of Patients by Place of Transplant, 1993-2008.................................88 6 72 69 7 Table 4.1.3 Distribution of Patients by Centres6 for Liver Transplantation, 1993-2008..........88 12 70 6 69 7 Table 4.2.1 Distribution of Patients by Gender, 1993-2008....................................................89 Table 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008..........................................90 Table 4.2.3 Distribution of Patients by Age, 1993-2008.........................................................91 Figure 4.4.2 Patient Survival by Gender, 1993-2008 Table 4.2.4 Primary Diagnosis, 1993-2008 (N=100)...............................................................92 Table 4.2.5 Indication for Transplantation, 1993-2008 (N=100).............................................92 Table 4.2.6 Recipientsâ&#x20AC;&#x2122; Blood Group, 1993-2008 ..................................................................93 Table 4.3.1 Distribution ofPatient PatientsSurvival by TypebyofGender Donors, 1993-2008.......................................94 Table 4.3.2 Immunosuppresive Drug Treatment at Transplantation, 1993-2008 (N=100).....94 Table 4.4.1 Patient Survival by Year of Transplant, 1993-2008 (N=100)...............................95 Table 4.4.2 Patient Survival by Gender, 1993-2008 (N=100).................................................96 Table 4.4.3 Patient Survival by Age Group, 1993-2008 (N=100)...........................................97 Table 4.4.4 Distribution of Patients by Cause of Death, 1993-2008 (N=100)........................98

List of Figures

0.00

0.25

Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008.........................................87 Figure 4.2.1 Distribution of Patients by Gender, 1993-2008...................................................89 Figure 4.2.2 Distribution of Patients by Ethnic Group, 1993-2008.........................................90 Figure 4.4.1 Patient Survival by Year of Transplant, 1993-2008............................................95 Figure 4.4.2 Patient Survival by Gender, 1993-2008..............................................................96 Figure 4.4.3 Patient Survival by Age Group, 1993-2008........................................................97 0

6 8 Duration in months Male

Female

Fifth Report of the National Registry 2008 Fifth Report of the of the Fifth Transplant Report National Transplant Registry 2008 2008 National Transplant Registry

LIVER TRANSPLANTATION LIVER TRANSPLANTATION

Table 4.4.3 Patient Survival by Age Group, 1993-2008 (N=100) 4.1 STOCK AND FLOW Age Group Interval (months)

0-9 years

Â&#x2022;10 years

The number of liver transplants performed from SE 1993 to 2008 one hundred. SE Eighty six % Survival % is Survival (86%) were performed locally and Five 1 81 fourteen (14%)5were performed85at overseas centres. 8 6 5 all done locally 80 at Selayang Hospital. 9 new liver transplants were done in702008 and they were 12

Table 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008 Figure 4.4.3 Patient93Survival Group, Year 94 95by Age 96 97* 98 1993-2008 99 00 01 02 03** 04 05 06 07 08

0.75

16 5 0 0

5 6 0 1

8 3 0 0

7 2 0 0

5 2 0 0

0.50

Cumulative Survival

1.00

New transplant patients 1 1 8 13 3 2 8 3 5 10 5 Deaths 0 0 Patient 3 4 Survival 1 1by Age 4 Group 1 2 5 1 Re-Transplant 0 0 0 0 0 0 0 0 0 0 0 Lost to follow up 0 0 0 0 0 0 0 1 0 1 0 Functioning graft at 1 2 7 16 18 19 23 24 27 31 35 31st December *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

Figure 4.1.1 Stock and Flow of Liver Transplantation, 1993-2008 Alive at 31st Dec

New patients

0.25

60 55

0.00

Number of patients (n)

50 45 40 0

6 8 Duration in months 0-9 years

Â&#x2022;10 years

25 20 15 10 5 0

1993

1994

1995

1996

1997

1998

1999

Year

2000

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2003

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Fifth Report of the National Transplant Registry Fifth Report of the Fifth Report of the2008 National Transplant National Transplant RegistryRegistry 2008 2008

LIVER TRANSPLANTATION LIVER TRANSPLANTATION

CHAPTER 5 RENAL TRANSPLANTATION Editor: Dr. Goh Bak Leong Expert Panel: Dato’ Dr. Zaki Morad b Mohd Zaher (Chair) Dr. Goh Bak Leong (Co-Chair) Dr. Fan Kin Sing Dr. Lily Mushahar Mr. Rohan Malek Dr. S. Prasad Menon Prof. Dr. Tan Si Yen Contents 5.1 Stock and Flow of Renal Transplantation x Stock and Flow x Transplant Rates x Places of Transplant x

5.2 Recipients’ Characteristics Demographics, Clinical and Serology Status x Primary Causes of ESRF

5.3 Transplant Practices x Type of Transplant Immunosuppressive Therapy and Other Medications x

5.4 Transplant Outcomes Post Transplantation Complications x Death and Graft Loss 5.5 Patient and Graft Survival

5.6 Cardiovascular Risk in Renal Transplant Recipients 5.7 QoL Index Score in Renal Transplant Recipients

FifthReport Reportofofthe the Fifth NationalTransplant TransplantRegistry Registry2008 2008 National

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oL-Index score in relation to Year of entry, 008…………………………………….…124 List of Tables

Table 5.1.1: Stock and Flow of Renal Transplantation, 1999-2008…………………102 Table 5.1.2: New Transplant Rate per million population (pmp), 1999-2008……… 103 Table 5.1.3: Transplant Prevalence Rate per million population (pmp), 1999-2008.. 103 nsplantation, 1975-2008…………………102 Table 5.1.4: Place of Transplantation, 1999-2008…………………………………...104 2008………………………………………103 Table 5.2.1: Renal Transplant Recipients’ Characteristics, 1999-2008…………….. 105 1975-2008………………………………..104 Table 5.2.2: Primary Causes of End Stage Renal Failure, 1999-2008……………… 105 th Rate, 1977-2008……………………….110 Table 5.3.1: Type of Renal Transplantation, 1999-2008…………………………… 106 ft Loss Rate, 1977-2008………………….110 Table 5.3.2: Biochemical Data, 2006-2008………………………………………… 106 ……………………………………………112 Table 5.3.3: Medication Data, 2006-2008………………………………………….. 108 …………………………………………...112 Table 5.4.1: Post-transplant Complications, 2006-2008……………………………..109 Transplant, 1995-2008………………….. Table 5.4.2: Transplant.113 Patients Death Rate and Graft Loss, 1999-2008………….. 110 ansplants, 1995-2008…………………….113 Table 5.4.3: Causes of Death in Transplant Recipients, 1999-2008………………... 111 Transplant (Living Related Transplant, Table 5.4.4: Causes 1995of Graft Failure, 1999-2008…………………………………… 111 …………………………………………... 114 Table 5.5.1: Patient Survival, 1995-2008…………………………………………… 112 ansplant (Living Related Table Transplant, 5.5.2: Graft 1995Survival, 1995-2008……………………………………………...112 …………………………………………... 114 by Type of Transplant, 1995-2008……………………113 Table 5.5.3: Patient Survival Transplant (Commercial Transplant, TableCadaver 5.5.4: Graft Survival by Type of Transplant, 1995-2008…………………….. 113 …………………………………………. 115 by Year of Transplant (Living Related Transplant, Table 5.5.5: Patient Survival ansplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………. 114 …………………………………………..115 Table 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, d Post Transplant Complications 1995-2008)……………………………………………………………..114 (in %) …………………………………………… 116 by Year of Transplant (Commercial Cadaver Transplant, Table 5.5.7: Patient Survival d Post Transplant Complications1995-2008)……………………………………………………………. (in %) 115 …………………………………………… 116 by Year of Transplant (Commercial Cadaver Transplant, Table 5.5.8: Graft Survival d Post Transplant Complications1995-2008)……………………………………………………………..115 (in %) …………………………………………… 116for IHD in Renal Transplant Recipients at Year 2006, 2007 Table 5.6.1: Risk Factors ……………………………………………..117 and 2008………………………………………………………………. 116 ……………………………………………117 Table 5.6.2(a): Systolic BP, 2006-2008…………………………………………….. 117 ……………………………………………118 Table 5.6.2(b): Diastolic BP, 2006-2008…………………………………………….117 ……………………………………………118 Table 5.6.3: CKD stages, 2006-2008……………………………………………….. 118 ………………………………………….. 119 Table 5.6.4: BMI, 2006-2008………………………………………………………. 118 008……………………………………… 120 Table 5.6.5(a): LDL, 2006-2008……………………………………………………. 119 ………………………………………….. 120 Table 5.6.5(b): Total Cholesterol, 2006-2008………………………………………. 119 oL- Index score in Table Transplant recipients, 5.6.5(c): HDL, 2006-2008……………………………………………………. 120 ………………………………………….. 122 for hypertension, 2006-2008……………………………..121 Table 5.6.6(a): Treatment oL- Index score in Table relation to Diabetes 5.6.6(b): Distribution of Systolic BP without anti-hypertensives, 2006-2008..121 ts 1999 – 2008………………………….. 122 of Diastolic BP without anti-hypertensives, 2006-2008.121 Table 5.6.6(c): Distribution QoL- Index score in Table relation to Gender, 5.6.6(d): Distribution of Systolic BP on anti-hypertensives, 2006-2008…….. 121 008……………………………………….123 Table 5.6.6(e): Distribution of Diastolic BP on anti-hypertensives, 2006-2008……. 121 QoL- Index score in Table relation to Age, 5.7.1: Cumulative distribution of QoL-Indexscore in Transplant recipients 1999008……………………………………… 123 2008…………………………………………………………………….122 QoL-Index score in relation to Year of entry, distribution of QoL-Index score in relation to Diabetes mellitus, Table 5.7.2: Cumulative 008……………………………………… 124 Transplant recipients 1999 – 2008……………………………………..122 Table 5.7.3: Cumulative distribution of QoL-Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Table 5.7.4: Cumulative distribution of QoL-Index score in relation to Age, Transplant recipients 1999-2008………………………………………………….. 123

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Table 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Table 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008…………………………………….…124 Transplant recipients 1999-2008…………………………………….…124 ListList of Figures of Figures Figure 5.1.1: Stock andand Flow of Renal Transplantation, 1975-2008…………………102 Figure 5.1.1: Stock Flow of Renal Transplantation, 1975-2008…………………102 Figure 5.1.2: New Transplant Rate, 1975-2008………………………………………103 Figure 5.1.2: New Transplant Rate, 1975-2008………………………………………103 Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 Figure 5.4.2(a): Transplant Recipient Death Rate, 1977-2008……………………….110 Figure 5.4.2(a): Transplant Recipient Death Rate, 1977-2008……………………….110 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.3: Patient Survival by by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.3: Patient Survival Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.5: Patient Survival by by Year of Transplant (Living Related Transplant, 1995Figure 5.5.5: Patient Survival Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114114 2008)…………………………………………………………………... Figure 5.5.6: Graft Survival by by Year of Transplant (Living Related Transplant, 1995Figure 5.5.6: Graft Survival Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114114 2008)…………………………………………………………………... Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………. 115115 1995-2008)……………………………………………………………. Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………..115 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram forfor PrePre andand Post Transplant Complications (in (in %)%) Figure 5.6.1(a): Venn Diagram Post Transplant Complications at year 2006…………………………………………………………… 116116 at year 2006…………………………………………………………… Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116116 at year 2007…………………………………………………………… Figure 5.6.1 (c):(c): Venn Diagram forfor PrePre andand Post Transplant Complications (in (in %)%) Figure 5.6.1 Venn Diagram Post Transplant Complications at year 2008…………………………………………………………… 116116 at year 2008…………………………………………………………… Figure 5.6.2(a): Systolic BP,BP, 2006-2008……………………………………………..117 Figure 5.6.2(a): Systolic 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.3: CKD stages by by year……………………………………………………118 Figure 5.6.3: CKD stages year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.5 (a):(a): LDL, 2006-2008………………………………………………….. 119119 Figure 5.6.5 LDL, 2006-2008………………………………………………….. Figure 5.6.5(b): Total Cholesterol, 2006-2008……………………………………… 120 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by by year……………………………………………………….. 120120 Figure 5.6.5(c): HDL year……………………………………………………….. Figure 5.7.1: Cumulative distribution of QoLIndex score in Transplant recipients, Figure 5.7.1: Cumulative distribution of QoLIndex score in Transplant recipients, 1999-2008…………………………………………………………….. 122122 1999-2008…………………………………………………………….. Figure 5.7.2: Cumulative distribution of QoLIndex score in relation to Diabetes Figure 5.7.2: Cumulative distribution of QoLIndex score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122122 mellitus, Transplant recipients 1999 – 2008………………………….. Figure 5.7.3: Cumulative distribution of QoLIndex score in relation to Gender, Figure 5.7.3: Cumulative distribution of QoLIndex score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoLIndex score in relation to Age, Figure 5.7.4: Cumulative distribution of QoLIndex score in relation to Age, Transplant recipients 1999-2008……………………………………… 123123 Transplant recipients 1999-2008……………………………………… Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124124 Transplant recipients 1999-2008………………………………………

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oL-Index score in relation to Year entry, AND FLOW SECTION 5.1:ofSTOCK 008…………………………………….…124 The number of new renal transplant patients shows an initial rise from 127 transplants per year in 1998 to a peak of 190 transplants in 2004. This is a rise of nearly 50% but the number declined subsequently to only 100 in 2007 (Table 5.1.1). This is due to reduction in the number of transplantations done in China. As renal transplantation in nsplantation, 1975-2008…………………102 the country is still dependant on the availability of commercial cadaveric 2008………………………………………103 transplantation done abroad this drop was foreseeable. There may be an increase post 1975-2008………………………………..104 2008 Beijing Olympic Games and this is supported by 88 transplants in year 2008. th Rate, 1977-2008……………………….110 The number of functioning renal transplants reported to the National Transplant ft Loss Rate, 1977-2008………………….110 Registry (NTR) had increased from 1178 in 1999 to 1730 in 2008 (Table 5.1.1). ……………………………………………112 Table 5.1.1: Stock and Flow of Renal Transplantation, 1999-2008 …………………………………………...112 Year 1999.1132000 2001 2002 2003 2004 2005 2006 2007 2008 Transplant, 1995-2008………………….. New transplant 127 143 163 172 160 190 162 141 100 88 ansplants, 1995-2008…………………….113 patients Transplant (Living Related Transplant, 25 1995- 30 Died 37 33 37 42 43 50 39 48 …………………………………………... Graft failure 37 114 32 40 39 42 44 21 38 37 32 Lost to Follow up 1 9 3 5 4 14 10 10 18 10 ansplant (Living Related Transplant, 1995Functioning graft 11781141250 1333 1428 1505 1595 1683 1726 1732 1730 …………………………………………... at 31st December Transplant (Commercial Cadaver Transplant, …………………………………………. Figure 5.1.1: Stock and 115 Flow of Renal Transplantation, 1975-2008 ansplant (Commercial Cadaver Transplant, …………………………………………..115 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 ……………………………………………..117 ……………………………………………117 ……………………………………………118 ……………………………………………118 ………………………………………….. 119 008………………………………………120 ………………………………………….. 120 oL- Index score in Transplant recipients, ………………………………………….. 122 oL- Index score in relation to Diabetes ts 1999 – 2008………………………….. 122 QoL- Index score in relation to Gender, 008……………………………………….123 QoL- Index score in relation to Age, 008……………………………………… 123 QoL-Index score in relation to Year of entry, 008……………………………………… 124

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Table Cumulative distribution of QoL-Index relation to Year entry, The5.7.5: incidence of renal transplantation stabilisedscore at a inmodest rate of 5-7ofper million Transplant recipients 1999-2008…………………………………….…124 population (Table 5.1.2) while transplant prevalence rate has grown slowly from 52 per million in 1999 to 64 per million population in 2007 (Table 5.1.3), an increase of 23% over the 1999 figures. However compared to growth in the prevalence rate of Listdialysis of Figures patients (which has increased by 300% from 205 in 1998 to 615 in 2007) our transplant prevalence rate has not kept up. In fact, the incidence rate and prevalence Figure Stock andinFlow Renal 1975-2008…………………102 rate 5.1.1: seem to reduce yearof2008 (3 Transplantation, and 62 per million population respectively (Table Figure New Transplant Rate, 1975-2008………………………………………103 5.1.25.1.2: and 5.1.3). Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 Figure 5.4.2(a): Transplant Recipient 1977-2008……………………….110 Table 5.1.2: New Transplant Rate perDeath millionRate, population (pmp), 1999-2008 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.3: Patient Survival by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: Graft by Rate, Type1975-2008 of Transplants, 1995-2008…………………….113 Figure 5.1.2: NewSurvival Transplant Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………. 115 Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2006…………………………………………………………… 116 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2008…………………………………………………………… 116 Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Table 5.1.3:CKD Transplant Rate per million population (pmp), 1999-2008 Figure 5.6.3: stagesPrevalence by year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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Figure 5.1.3: Transplant oL-Index score in relation to Year of entry,Prevalence Rate, 1975-2008 008…………………………………….…124

nsplantation, 1975-2008…………………102 2008………………………………………103 1975-2008………………………………..104 th Rate, 1977-2008……………………….110 ft Loss Rate, 1977-2008………………….110 ……………………………………………112 …………………………………………...112 Transplant, 1995-2008………………….. .113 ansplants, 1995-2008…………………….113 Transplant (Living Related Transplant, 1995…………………………………………... 114 Table 5.1.4: Place of Transplantation, 1999-2008 ansplant (Living Related Transplant, 1995…………………………………………... 114 Transplant (Commercial Cadaver Transplant, …………………………………………. 115 ansplant (Commercial Cadaver Transplant, …………………………………………..115 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 ……………………………………………..117 ……………………………………………117 ……………………………………………118 ……………………………………………118 ………………………………………….. 119 008………………………………………120 ………………………………………….. 120 oL- Index score in Transplant recipients, ………………………………………….. 122 oL- Index score in relation to Diabetes ts 1999 – 2008………………………….. 122 terms to ofGender, place of transplantation, transplantation within local centres has remained QoL- Index score in In relation the quite same from 1999 to 2007, with 52 to 53 cases (51% of all renal transplants), 008……………………………………….123 has decreased QoL- Index score in but relation to Age, to 46 in 2008. This is disturbing data as it underscores our failure to improve transplantation 008……………………………………… 123rates within the country which is mainly due to the lack of both living as well as QoL-Index score in relation to Year of entry,cadaver donors. Transplantation in China in 2008 comprised 47% of all of renal transplant recipients with 41 patients.dfggfgdfgfdgfdgfdgfdgfdg 008……………………………………… 124

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Table 5.7.5: Cumulative distributionCHARACTERISTICS of QoL-Index score in relation to Year of entry, SECTION 5.2: RECIPIENTS’ Transplant recipients 1999-2008…………………………………….…124 In terms of renal transplant recipients’ characteristics, age at transplant has been stable at 34 to 42 years. Between 58% and 70% of recipients were males over the last 10 years. There has been an increase in the proportion of diabetic patients undergoing Listtransplantation of Figures from 11% in 1998 to 21% in 2006 (Table 5.2.1). However, there is a drastic drop in number of diabetic patients who underwent transplantation in 2007 and Figure and Flow of Renal Transplantation, 1975-2008…………………102 20085.1.1: (14%Stock and 15% respectively). This coincided with the drop in China transplants Figure 5.1.2: Transplant 1975-2008………………………………………103 where the New majority of the Rate, diabetic patients underwent their transplantation. Patients Figure Transplant Prevalence Rate, 1975-2008………………………………..104 with5.1.3: hepatitis B and hepatitis C remained static at around 4-8%. In terms of cause of Figure Transplant Recipient Death 1977-2008……………………….110 end 5.4.2(a): stage renal failure (Table 5.2.2), theRate, primary cause was still glomerulonephritis, Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, followed by hypertension and diabetes as the third1977-2008………………….110 cause. Up to 40% of transplant Figure 5.5.1: Patient 1995-2008……………………………………………112 recipients had endSurvival, stage renal disease due to unknown causes, belying the fact that Figure 5.5.2:ofGraft 1995-2008……………………………………………...112 majority theseSurvival, patients presented late. Figure 5.5.3: Patient Survival by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: by Recipients’ Type of Transplants, 1995-2008…………………….113 Table 5.2.1:Graft RenalSurvival Transplant Characteristics, 1999-2008 Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………. 115 Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant Complications (in %) at Primary year 2006…………………………………………………………… 116 Table 5.2.2: Causes of End Stage Renal Failure, 1999-2008 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2008…………………………………………………………… 116 Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.3: CKD stages by year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation to Year entry, SECTION 5.3:ofTRANSPLANT PRACTICES 008…………………………………….…124 In 2006, 62% of the renal transplant recipients received their grafts from commercial sources. Fifty-eight percent of these were from commercial cadavers. Live donor transplantation made up 20% of transplants (28 recipients) in the same year which was down from 45 cases (37%) in 1999 and 40 cases (24%) in 2005. Since 2006, the number of life donor has remained low - 31 in 2007 and 25 in 2008. Local cadaveric nsplantation, 1975-2008…………………102 donation made up 18% of transplants (24 recipients) in 2006 although it had shown an 2008………………………………………103 initial promising rise to 37 recipients in 2001. 2007 marked the first time in 10 years 1975-2008………………………………..104 where there were more local transplantations (57%) compared to commercial th Rate, 1977-2008……………………….110 transplantations in oversea (41%). ft Loss Rate, 1977-2008………………….110 ……………………………………………112 Table 5.3.1: Type of Renal Transplantation, 1999-2008 …………………………………………...112 Transplant, 1995-2008………………….. .113 ansplants, 1995-2008…………………….113 Transplant (Living Related Transplant, 1995…………………………………………... 114 ansplant (Living Related Transplant, 1995…………………………………………... 114 Transplant (Commercial Cadaver Transplant, …………………………………………. 115 ansplant (Commercial Cadaver Transplant, …………………………………………..115 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) Table 5.3.2: Biochemical Data, 2006-2008 …………………………………………… 116 ……………………………………………..117 ……………………………………………117 ……………………………………………118 ……………………………………………118 ………………………………………….. 119 008………………………………………120 ………………………………………….. 120 oL- Index score in Transplant recipients, ………………………………………….. 122 oL- Index score in relation to Diabetes ts 1999 – 2008………………………….. 122 QoL- Index score in relation to Gender, 008……………………………………….123 QoL- Index score in relation to Age, 008……………………………………… 123 QoL-Index score in relation to Year of entry, 008……………………………………… 124

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Table 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008…………………………………….…124 List of Figures Figure 5.1.1: Stock and Flow of Renal Transplantation, 1975-2008…………………102 Figure 5.1.2: New Transplant Rate, 1975-2008………………………………………103 Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 Figure 5.4.2(a): Transplant Recipient Death Rate, 1977-2008……………………….110 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.3: Patient Survival by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………. 115 Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2006…………………………………………………………… 116 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2008…………………………………………………………… 116 Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.3: CKD stages by year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation to Year of entry,Data, 2006-2008 Table 5.3.3: Medication 008…………………………………….…124

nsplantation, 1975-2008…………………102 2008………………………………………103 1975-2008………………………………..104 th Rate, 1977-2008……………………….110 ft Loss Rate, 1977-2008………………….110 ……………………………………………112 …………………………………………...112 Transplant, 1995-2008………………….. .113 ansplants, 1995-2008…………………….113 Transplant (Living Related Transplant, 1995…………………………………………... 114 ansplant (Living Related Transplant, 1995…………………………………………... 114 Transplant (Commercial Cadaver Transplant, …………………………………………. 115 In 2008, Cyclosporine ansplant (Commercial Cadaver Transplant,based regimes remained the mainstay of immunosuppressive therapy with 69% of patients receiving it. This showed a gradual declining trend from …………………………………………..115 80% of all immunosuppression used since 2004 which coincided with increasing d Post Transplant Complications (in %) trend in Tacrolimus usage. …………………………………………… 116 Tacrolimus based regimes accounted for 24%. There has been continuous increase in the use of Mycophenolate Mofetil as the second d Post Transplant Complications (in %) immunosuppressive agent …………………………………………… 116 in 53% of patients in 2008 compared to 37% of patients in 2004. During the same d Post Transplant Complications (in %) period, the use of Azathioprine declined from 43% in 2004 to 28% in 2008. Monotherapy of immunosuppresion is mostly not noted except in a …………………………………………… 116 small number of patients. Sirolimus was used in 2% of all transplant recipients in ……………………………………………..117 2008. ……………………………………………117 ……………………………………………118 In terms of non immunosuppressive medications, in year 2008 only 31% of patients ……………………………………………118 were on ACE inhibitors ………………………………………….. 119or Angiotensin II receptor blockers (AIIRB) or both and this trend has been relatively 008………………………………………120static since 2004. Calcium Channel blockers appeared to be the mainstay of antihypertensive therapy in 50% of patients whilst Beta Blockers use ………………………………………….. 120 was reported in 45% of patients. Other antihypertensives were reported in 14% of oL- Index score in Transplant recipients, patients. The widespread ………………………………………….. 122 use of Calcium Channel blockers either as monotherapy or combination may be due to the use of the dihydropyridine group to minimise the dose oL- Index score in relation to Diabetes of cyclosporine, which122 remains the main immunosuppressive drug. ts 1999 – 2008………………………….. QoL- Index score in relation to Gender, 008……………………………………….123 QoL- Index score in relation to Age, 008……………………………………… 123 QoL-Index score in relation to Year of entry, 008……………………………………… 124

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Table 5.7.5: Cumulative distribution OUTCOMES of QoL-Index score in relation to Year of entry, SECTION 5.4: TRANSPLANT Transplant recipients 1999-2008…………………………………….…124 5.4.1 Post-transplant Complications ListInofthe Figures year 2008, sixty-two percent of patients were hypertensive prior to transplantation whereas 27% developed hypertension post transplantation. Fourteen Figure 5.1.1: and had Flowdiabetes of Renalmellitus Transplantation, percent ofStock patients prior to 1975-2008…………………102 transplant whereas only 7% of Figure 5.1.2: New Transplant Rate, 1975-2008………………………………………103 patients developed post transplant diabetes mellitus. These trends have been quite the Figure Rate, 1975-2008………………………………..104 same5.1.3: sinceTransplant 2006. In Prevalence terms of cardiovascular and cerebrovascular disease 4% had Figure 5.4.2(a): Recipient Death Rate, 1977-2008……………………….110 either or bothTransplant prior to transplant whereas 5% developed these post transplantation. Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Survival,Complications, 1995-2008……………………………………………112 Table 5.4.1:Patient Post-transplant 2006-2008 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.3: Patient Survival by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………. 115 Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2006…………………………………………………………… 116 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) 5.4.2 Deaths and2007…………………………………………………………… Graft Loss at year 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) In 2008, 48 transplant recipients died and 32 lost their grafts. The rates of transplant at year 2008…………………………………………………………… 116 death and graft loss have remained static for the past 10 years (Table 5.4.2). The main Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 known causesDiastolic of deathBP, have been infection and cardiovascular disease with 26% and Figure 5.6.2(b): 2006-2008……………………………………………117 13% respectively. Another 23% of patients died at home, which is usually presumed Figure 5.6.3: CKD stages by year……………………………………………………118 to be5.6.4: cardiovascular death as well. Figure BMI by year……………………………………………………………118 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Cancer death Total rates Cholesterol, have been significantly high since 2003 contributing to 15%120 of all Figure 5.6.5(b): 2006-2008……………………………………… deaths in 2003, 17% in 2004 and 19% in 2008. Death due to liver disease Figure 5.6.5(c): HDL by year……………………………………………………….. 120has remained static at 5-9% from 2003Index to 2006. Figure 5.7.1:relatively Cumulative distribution of QoLscore in Transplant recipients, 1999-2008…………………………………………………………….. 122 In terms graft loss, distribution 72% were due to rejection with in 6%relation apiece to forDiabetes vascular causes Figure 5.7.2:ofCumulative of QoLIndex score and infections in 2008 and these figures 1999 have –remained relatively stable for the 122 last 4 mellitus, Transplant recipients 2008………………………….. years. Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation to Year of entry,Patients Death Rate and Graft Loss, 1999-2008 Table 5.4.2: Transplant 008…………………………………….…124

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Table 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Table 5.4.3: Causes of Death in Transplant Recipients, 1999-2008 Transplant recipients 1999-2008…………………………………….…124 List of Figures Figure 5.1.1: Stock and Flow of Renal Transplantation, 1975-2008…………………102 Figure 5.1.2: New Transplant Rate, 1975-2008………………………………………103 Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 Figure 5.4.2(a): Transplant Recipient Death Rate, 1977-2008……………………….110 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.3: Patient Survival by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………. 115 Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, Table 5.4.4: Causes of Graft Failure, 1999-2008 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2006…………………………………………………………… 116 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2008…………………………………………………………… 116 Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.3: CKD stages by year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation to Year ofAND entry,GRAFT SURVIVAL 5.5: PATIENT 008…………………………………….…124 Overall patient survival rates from 1995 to 2008 have been 95%, 91%, 88% and 81% at year 1, 3, 5 and 10 respectively. Overall graft survival rate has been 91%, 85%, 80% and 66% at year 1, 3, 5 and 10 respectively. Table 5.5.1: Patient Survival, 1995-2008

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Figure 5.5.1: Patient Survival, 1995-2008

Figure 5.5.2: Graft Survival, 1995-2008

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Table 5.7.5: Cumulative distribution offrom QoL-Index score in relation Year of Outcomes of renal transplantation the 4 donor groups aretoshown in entry, respect to Transplant recipients 1999-2008…………………………………….…124 patient and graft survival in the Kaplan Meier survival graphs in Figures 5.5.3 and 5.5.4 respectively. In terms of patient survival, live donor grafts maintained good survival rates with 96%, 95%, 94% and 89% at years 1, 3, 5 and 10 respectively. In Listterms of Figures of graft survival, commercial cadaver grafts performed similarly well with a survival of 94%, 89%, 82% and 70% at year 1, 3, 5 and 10 compared to 92%, 88%, Figure Stock Renal Transplantation, 1975-2008…………………102 84%5.1.1: and 68% forand theFlow sameof intervals for live donor grafts. Figure 5.1.2: New Transplant Rate, 1975-2008………………………………………103 Table 5.5.3:Transplant Patient Survival by Type of Transplant, 1995-2008 Figure 5.1.3: Prevalence Rate, 1975-2008………………………………..104 Figure 5.4.2(a): Transplant Recipient Death Rate, 1977-2008……………………….110 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.3: Patient Survival by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.7: Year of TransplantFigure (Commercial Transplant, Figure 5.5.3:Patient Patient Survival Survival byby Type of Transplant, 5.5.4: GraftCadaver Survival by Type of 1995-2008 Transplants, 1995-2008115 1995-2008)……………………………………………………………. Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2006…………………………………………………………… 116 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2008…………………………………………………………… 116 Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.3: CKD stages by year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Table 5.5.4: Graft by Type of Transplant, 1995-2008 Figure 5.6.5(b): TotalSurvival Cholesterol, 2006-2008……………………………………… 120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation Yeargraft of entry, Patient toand survival for living related transplants were compared for two 008…………………………………….…124 cohorts. The 1995-2000 cohort and the 2001-2008 cohort were compared for patient survival (Figures 5.5.5) but both were comparable and survival remained excellent for both groups.

Graft survival for living related transplants (Figure 5.5.6) however was much better in nsplantation, 1975-2008…………………102 patients in the 2001-2008 cohort even from the outset probably due to increased usage 2008………………………………………103 of newer immunosuppressive agents. 1975-2008………………………………..104 Table 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 1995-2008) th Rate, 1977-2008……………………….110 ft Loss Rate, 1977-2008………………….110 ……………………………………………112 …………………………………………...112 Transplant, 1995-2008………………….. .113 ansplants, 1995-2008…………………….113 Transplant (Living Related Transplant, 1995…………………………………………... 114 ansplant (Living Related Transplant, 1995…………………………………………... 114by Year of Transplant Figure 5.5.5: Patient Survival Figure 5.5.6: Graft Survival by Year of Transplant Transplant (Commercial Cadaver Transplant, (Living Related Transplant, 1995-2008) (Living Related Transplant, 1995-2008) …………………………………………. 115 ansplant (Commercial Cadaver Transplant, …………………………………………..115 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 ……………………………………………..117 ……………………………………………117 ……………………………………………118 ……………………………………………118 Table 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 1995-2008) ………………………………………….. 119 008………………………………………120 ………………………………………….. 120 oL- Index score in Transplant recipients, ………………………………………….. 122 oL- Index score in relation to Diabetes ts 1999 – 2008………………………….. 122 QoL- Index score in relation to Gender, 008……………………………………….123 QoL- Index score in relation to Age, 008……………………………………… 123 QoL-Index score in relation to Year of entry, 008……………………………………… 124

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Table 5.7.5: of Cumulative distribution QoL-Index score relation to between Year of entry, In terms commercial cadavericoftransplantation, theincomparison the 1995Transplant recipients 1999-2008…………………………………….…124 2000 cohort and 2001-2008 cohort was performed. Both patient and graft survival showed comparable results to living related transplants done within the country. List of Figures

Table 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 19952008) Figure 5.1.1: Stock and Flow of Renal Transplantation, 1975-2008…………………102

Figure 5.1.2: New Transplant Rate, 1975-2008………………………………………103 Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 Figure 5.4.2(a): Transplant Recipient Death Rate, 1977-2008……………………….110 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.3: Patient Survival by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.7: Patient Survival by Year of Transplant Figure 5.5.8: Graft Survival by Year of Transplant Figure 5.5.6: Graft Survival by Year of Transplant (Living(Commercial Related Transplant, 1995(Commercial Cadaver Transplant, 1995-2008) Cadaver Transplant, 1995-2008) 2008)…………………………………………………………………... 114 Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………. 115 Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2006…………………………………………………………… 116 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2008…………………………………………………………… 116 Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.3: CKD by year……………………………………………………118 Table 5.5.8: Graftstages Survival by Year of Transplant (Commercial Cadaver Transplant, 1995Figure 5.6.4: BMI by year……………………………………………………………118 2008) Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation to Year5.6: of entry, SECTION CARDIOVASCULAR RISK IN RENAL TRANSPLANT 008…………………………………….…124 RECIPIENTS 5.6.1 Risk Factors for Ischaemic Heart Disease

In 2008, 85.2% of patients were hypertensive, 23.2% were diabetic and 56.8% had nsplantation, 1975-2008…………………102 renal insufficiency fulfilling CKD III and above. Forty-five percent of patients had 2 2008………………………………………103 cardiovascular risk factors while 10% had all 3 major risk factors. 1975-2008………………………………..104 th Rate, 1977-2008……………………….110 Table 5.6.1: Risk Factors for IHD in Renal Transplant Recipients at Year 2006, 2007 and 2008 ft Loss Rate, 1977-2008………………….110 ……………………………………………112 …………………………………………...112 Transplant, 1995-2008………………….. .113 ansplants, 1995-2008…………………….113 Transplant (Living Related Transplant, 1995…………………………………………... 114 ansplant (Living Related Transplant, 1995…………………………………………... 114 Transplant (Commercial Cadaver Transplant, …………………………………………. 115 ansplant (Commercial Cadaver Transplant, …………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Figure 5.6.1(b): Venn Diagram for Pre and Post d Post Transplant Complications (in Complications %) Transplant (in %) at year 2006 Transplant Complications (in %) at year 2007 …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 ……………………………………………..117 ……………………………………………117 ……………………………………………118 ……………………………………………118 ………………………………………….. 119 008………………………………………120 ………………………………………….. 120 oL- Index score in Transplant recipients, ………………………………………….. 122 for Pre and Post Figure 5.6.1 (c): Venn Diagram oL- Index score in relationTransplant to Diabetes Complications (in %) at year 2008 ts 1999 – 2008………………………….. 122 QoL- Index score in relation to Gender, 008……………………………………….123 QoL- Index score in relation to Age, 008……………………………………… 123 QoL-Index score in relation to Year of entry, 008……………………………………… 124

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Table 5.7.5: Cumulative of QoL-Index score in relation to Year of2006, entry,2007, 5.6.2 Blood Pressuredistribution Classification According to JNC VI Criteria, Transplant recipients 1999-2008…………………………………….…124 and 2008 In 2008, 22% of renal transplant recipients had stage I hypertension whereas 5% had Liststage of Figures II hypertension and 0.7% had stage III hypertension despite being on treatment. In terms of diastolic hypertension 13% had stage I hypertension, 1.4% of patients had Figure Stock andhypertension Flow of Renaland Transplantation, 1975-2008…………………102 stage5.1.1: II diastolic 0.33% of patients had stage III diastolic Figure 5.1.2: New Transplant 1975-2008………………………………………103 hypertension despite being Rate, on treatment. Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 Figure 5.4.2(a): Recipient Death Rate, 1977-2008……………………….110 Table 5.6.2(a):Transplant Systolic BP, 2006-2008 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.3: Patient Survival by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.6.2(a): Systolic 2006-2008 5.6.2(b): Cadaver Diastolic BP, 2006-2008 Figure 5.5.7: Patient Survival byBP, Year of Transplant Figure (Commercial Transplant, 1995-2008)……………………………………………………………. 115 Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2006…………………………………………………………… 116 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2008…………………………………………………………… 116 Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.3: CKD stages by year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Table 5.6.2(b): Diastolic BP, 2006-2008 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation to Year of stages, entry, 2006-2008 Table 5.6.3: CKD 008…………………………………….…124

nsplantation, 1975-2008…………………102 2008………………………………………103 1975-2008………………………………..104 Table 5.6.3 shows the CKD th Rate, 1977-2008……………………….110 Stage classification by year and ft Loss Rate, 1977-2008………………….110 in 2008, 43.5% of renal ……………………………………………112 transplant recipients had CKD …………………………………………...112 Stage III whilst another 7.2% Transplant, 1995-2008………………….. .113 had CKD Stage IV. CKD Stage ansplants, 1995-2008…………………….113 V (impending renal Transplant (Living Related Transplant, 1995replacement therapy) was …………………………………………... 114 found in 1.6% of renal ansplant (Living Related Transplant, 1995transplant recipients. …………………………………………... 114 Transplant (Commercial Cadaver Transplant, …………………………………………. 115 ansplant (Commercial Cadaver Transplant, …………………………………………..115 Table 5.6.4: BMI, 2006-2008 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 ……………………………………………..117 ……………………………………………117 In terms of BMI for 2008, ……………………………………………118 55.5% of renal transplant ……………………………………………118 recipients had BMIs 119 of 25 or ………………………………………….. below. However 30.1% 008……………………………………… 120 were overweight and another ………………………………………….. 120 14% obese.recipients, There seems to be a oL- Index score in were Transplant slow but steady in …………………………………………..increase 122 obese patients over oL- Index score in numbers relation toofDiabetes the last few years. ts 1999 – 2008………………………….. 122 QoL- Index score in relation to Gender, 008……………………………………….123 QoL- Index score in relation to Age, 008……………………………………… 123 QoL-Index score in relation to Year of entry, 008……………………………………… 124

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Figure 5.6.3: CKD stages by year

Figure 5.6.4: BMI by year

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Table 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Table 5.6.5(a): LDL, 2006-2008 Transplant recipients 1999-2008…………………………………….…124 List of Figures Figure 5.1.1: Stock and Flow of Renal Transplantation, 1975-2008…………………102 Figure 5.6.5 (a): LDL, 2006-2008 LDL5.1.2:cholesterol has Rate, been Figure New Transplant 1975-2008………………………………………103 identified as the primary lipid Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 target for prevention of coronary Figure 5.4.2(a): Transplant Recipient Death Rate, 1977-2008……………………….110 heart5.4.2(b): disease Transplant by NCEP with a logGraft Loss Rate, 1977-2008………………….110 Figure Recipient linear relationship between 1995-2008……………………………………………112 risk of Figure 5.5.1: Patient Survival, CHD and level of LDL Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 cholesterol. In Survival terms ofby renal Figure 5.5.3: Patient Type of Transplant, 1995-2008………………….. .113 transplant recipients 2008of Transplants, 1995-2008…………………….113 Figure 5.5.4: Graft Survival in by Type 35.6% have LDL Survival levels below 2.6 of Transplant (Living Related Transplant, 1995Figure 5.5.5: Patient by Year mol/l and 2008)…………………………………………………………………... this shows an increasing 114 trend from 18.1% in 2004, Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 1995possibly 2008)…………………………………………………………………... due to the more 114 widespread and aggressive of of Transplant (Commercial Cadaver Transplant, Figure 5.5.7: Patient Survival byuse Year statins. Whether or not this 1995-2008)……………………………………………………………. 115 translates into less cardiovascular Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, mortality 1995-2008)……………………………………………………………..115 in the transplant population is stillDiagram questionable. Figure 5.6.1(a): Venn for Pre and Post Transplant Complications (in %) Patients with serum LDL >3.4 also at year 2006…………………………………………………………… 116 demonstrated downward trend Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) over the last few years. at year 2007…………………………………………………………… 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) In terms ofatother parameters for 2008, 56% had total cholesterol levels >= year cholesterol 2008…………………………………………………………… 116 5.2 and 6.2% Systolic had HDLBP, cholesterol levels <1.0 . Figure 5.6.2(a): 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Table 5.6.5(b): Total Cholesterol, 2006-2008 Figure 5.6.3: CKD stages by year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation Year of entry, Figure to 5.6.5(b): Total Cholesterol, 2006-2008 008…………………………………….…124

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Table 5.7.5: Cumulative QoL-Index in relation to Year Eighty-six percent ofdistribution patients in of2008 were onscore antihypertensives and of theentry, majority Transplant recipients 1999-2008…………………………………….…124 were on more than 1 antihypertensive drug with 31% on 2 antihypertensives and 21% on 3 antihypertensives. Six percent of patients still had systolic BP of > 160 mmHg and 17% had diastolic BP of > 90 mmHg despite being given antihypertensive(s), Listhowever, of Figures this is an improvement from previous years. Figure 5.1.1: Stock and Flow Renal Transplantation, Table 5.6.6(a): Treatment forofhypertension, 2006-2008 1975-2008…………………102 Figure 5.1.2: New Transplant Rate, 1975-2008………………………………………103 Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 Figure 5.4.2(a): Transplant Recipient Death Rate, 1977-2008……………………….110 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Table 5.6.6(b): Distribution without anti-hypertensives, 2006-2008 Figure 5.5.3: Patient Survivalof bySystolic Type ofBPTransplant, 1995-2008………………….. .113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, Table 5.6.6(c): Distribution of Diastolic BP without anti-hypertensives, 2006-2008 1995-2008)……………………………………………………………. 115 Figure 5.5.8: Graft Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………..115 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2006…………………………………………………………… 116 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116 Table 5.6.6(d): Distribution of Systolic BP on anti-hypertensives, 2006-2008 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2008…………………………………………………………… 116 Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.3: CKD stages by year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Table 5.6.6(e): Distribution of Diastolic BP on anti-hypertensives, 2006-2008 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation to Year entry,INDEX SCORE IN RENAL TRANSPLANT RECIPIENTS SECTION 5.7:ofQOL 008…………………………………….…124 1179 patients who were transplanted between 1999-2008 were analysed for QoL index score. They reported median QoL index score of 10 (Table 5.7.1 and Figure 5.7.1). It was interesting to note that for those who underwent renal transplantation between this period, diabetics and non-diabetics had the same median QoL index nsplantation, 1975-2008…………………102 score of 10 (Table 5.7.2 and Figure 5.7.2), and this is in contrast to HD and CAPD 2008………………………………………103 patients where diabetics reported lower QoL index score than non-diabetics. There 1975-2008………………………………..104 was also no difference seen between gender (Table 5.7.3 and Figure 5.7.3) and age th Rate, 1977-2008……………………….110 (Table 5.7.4 and Figure 5.7.4). It is worthwhile to note that those above 60 years old ft Loss Rate, 1977-2008………………….110 also enjoyed the same QoL index score (10) as their younger counterparts (Table ……………………………………………112 5.7.4 and Figure 5.7.4). This trend of high QoL index score among renal transplant …………………………………………...112 patients was maintained over the last 10 years (Table 5.7.5 and Figure 5.7.5). Transplant, 1995-2008………………….. .113 ansplants, 1995-2008…………………….113 Table 5.7.1: Cumulative distribution of QoL- Figure 5.7.1: Cumulative distribution of QoLIndexscore in Transplant recipients 1999 - 2008 Index score in Transplant recipients, 1999 - 2008 Transplant (Living Related Transplant, 1995…………………………………………... 114 ansplant (Living Related Transplant, 1995…………………………………………... 114 Transplant (Commercial Cadaver Transplant, …………………………………………. 115 ansplant (Commercial Cadaver Transplant, …………………………………………..115 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 d Post Transplant Complications (in %) …………………………………………… 116 ……………………………………………..117 Table 5.7.2: Cumulative distribution of QoL- Figure 5.7.2: Cumulative distribution of QoL……………………………………………117 Index score in relation to Diabetes mellitus, Index score in relation to Diabetes mellitus, ……………………………………………118 Transplant recipients 1999 – 2008 Transplant recipients 1999 - 2008 ……………………………………………118 ………………………………………….. 119 008………………………………………120 ………………………………………….. 120 oL- Index score in Transplant recipients, ………………………………………….. 122 oL- Index score in relation to Diabetes ts 1999 – 2008………………………….. 122 QoL- Index score in relation to Gender, 008……………………………………….123 QoL- Index score in relation to Age, 008……………………………………… 123 QoL-Index score in relation to Year of entry, 008……………………………………… 124

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Table 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008…………………………………….…124 Table 5.7.3: Cumulative distribution of QoLIndex score in relation to Gender, Transplant Listrecipients of Figures 1999-2008

Figure 5.7.3: Cumulative distribution of QoLIndex score in relation to Gender, Transplant recipients 1999-2008

Figure 5.1.1: Stock and Flow of Renal Transplantation, 1975-2008…………………102 Figure 5.1.2: New Transplant Rate, 1975-2008………………………………………103 Figure 5.1.3: Transplant Prevalence Rate, 1975-2008………………………………..104 Figure 5.4.2(a): Transplant Recipient Death Rate, 1977-2008……………………….110 Figure 5.4.2(b): Transplant Recipient Graft Loss Rate, 1977-2008………………….110 Figure 5.5.1: Patient Survival, 1995-2008……………………………………………112 Figure 5.5.2: Graft Survival, 1995-2008……………………………………………...112 Figure 5.5.3: Patient Survival by Type of Transplant, 1995-2008………………….. .113 Figure 5.5.4: Graft Survival by Type of Transplants, 1995-2008…………………….113 Figure 5.5.5: Patient Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.6: Graft Survival by Year of Transplant (Living Related Transplant, 19952008)…………………………………………………………………... 114 Figure 5.5.7: Patient Survival by Year of Transplant (Commercial Cadaver Transplant, 1995-2008)……………………………………………………………. 115 Figure 5.5.8: Graft Survival by Year of Transplant Cadaver Transplant, Table 5.7.4: Cumulative distribution of QoL- (Commercial Figure 5.7.4: Cumulative distribution of QoLIndex score in relation to Age, Transplant Index score in relation to Age, Transplant 1995-2008)……………………………………………………………..115 recipients 1999-2008 recipientsComplications 1999-2008 Figure 5.6.1(a): Venn Diagram for Pre and Post Transplant (in %) at year 2006…………………………………………………………… 116 Figure 5.6.1(b): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2007…………………………………………………………… 116 Figure 5.6.1 (c): Venn Diagram for Pre and Post Transplant Complications (in %) at year 2008…………………………………………………………… 116 Figure 5.6.2(a): Systolic BP, 2006-2008……………………………………………..117 Figure 5.6.2(b): Diastolic BP, 2006-2008……………………………………………117 Figure 5.6.3: CKD stages by year……………………………………………………118 Figure 5.6.4: BMI by year……………………………………………………………118 Figure 5.6.5 (a): LDL, 2006-2008………………………………………………….. 119 Figure 5.6.5(b): Total Cholesterol, 2006-2008………………………………………120 Figure 5.6.5(c): HDL by year……………………………………………………….. 120 Figure 5.7.1: Cumulative distribution of QoL- Index score in Transplant recipients, 1999-2008…………………………………………………………….. 122 Figure 5.7.2: Cumulative distribution of QoL- Index score in relation to Diabetes mellitus, Transplant recipients 1999 – 2008………………………….. 122 Figure 5.7.3: Cumulative distribution of QoL- Index score in relation to Gender, Transplant recipients 1999-2008……………………………………….123 Figure 5.7.4: Cumulative distribution of QoL- Index score in relation to Age, Transplant recipients 1999-2008……………………………………… 123 Figure 5.7.5: Cumulative distribution of QoL-Index score in relation to Year of entry, Transplant recipients 1999-2008……………………………………… 124

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oL-Index score in relation to YearCumulative of entry, distribution of QoL-Index score in relation to Year of entry, Table 5.7.5: 008…………………………………….…124 Transplant recipients 1999-2008

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CHAPTER 6 HOMOGRAFT - HEART VALVE TRANSPLANTATION Editor: Mr. Mohamed Ezani Hj Md Taib Expert Panel: Mr Mohamed Ezani Md. Taib (Chairperson) Dr Abdul Rais Sanusi Datuk Dr Aizai Azan Abdul Rahim Dr Ashari Yunus Dato’ Dr David Chew Soon Ping Contents 6.0 Introduction 6.1 Stock and Flow 6.2 Recipients’ Characteristics x Demographics 6.3 Transplant Practices x Donor Details x Type of Transplant 6.4 Transplant Outcomes x Patient Survival

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List List of of Tables Tables Table Table 6.1.1: 6.1.1: Stock Stock and and Flow, Flow, 1996-2008 1996-2008..................................................................... .....................................................................128 128 Table Table 6.2.1: 6.2.1: Distribution Distribution of of Patients Patients by by Gender, Gender, 1996-2008 1996-2008....................................... .......................................129 129 Table Table 6.2.2: 6.2.2: Distribution Distribution of of Patients Patients by by Ethnic Ethnic Group, Group, 1996-2008 1996-2008............................. .............................130 130 Table Table 6.2.3: 6.2.3: Distribution Distribution of of Patients Patients by by Age, Age, 1996-2008 1996-2008............................................ ............................................131 131 Table Table 6.3.1: 6.3.1: Number Number of of Valves Valves Harvested Harvested by by Type Type of of Homograft, Homograft, 1996-2008 1996-2008 .......... ..........132 132 Table Table 6.3.2: 6.3.2: Type Type of of Transplant, Transplant, 1996-2008 1996-2008 ............................................................... ...............................................................132 132 Table Table 6.4.1: 6.4.1: Patient Patient Survival Survival by by Gender, Gender, 1996-2008................................................... 1996-2008...................................................133 133 Table Table 6.4.2: 6.4.2: Patient Patient Survival Survival by by Age Age Group, Group, 1996-2008............................................. 1996-2008.............................................134 134 Table Table 6.4.3: 6.4.3: Patient Patient Survival Survival by by Type Type of of Homograft, Homograft, 1996-2008 1996-2008 ............................... ...............................135 135 List List of of Figures Figures Figure Figure 6.1.1: 6.1.1: Stock Stock and and Flow, Flow, 1996-2008.................................................................... 1996-2008....................................................................128 128 Figure Figure 6.2.1: 6.2.1: Distribution Distribution of of Patients Patients by by Gender, Gender, 1996-2008...................................... 1996-2008......................................129 129 Figure Figure 6.2.2: 6.2.2: Distribution Distribution of of Patients Patients by by Ethnic Ethnic Group, Group, 1996-2008............................ 1996-2008............................130 130 Figure Figure 6.2.3: 6.2.3: Distribution Distribution of of Patients Patients by by Age, Age, 1996-2008........................................... 1996-2008...........................................131 131 Figure Figure 6.3.2: 6.3.2: Type Type of of Transplant, Transplant, 1996-2008 1996-2008.............................................................. ..............................................................132 132 Figure Figure 6.4.1: 6.4.1: Patient Patient Survival Survival by by Gender, Gender, 1996-2008 1996-2008 ................................................. .................................................133 133 Figure Figure 6.4.2: 6.4.2: Patient Patient Survival Survival by by Age Age Group, Group, 1996-2008 1996-2008........................................... ...........................................134 134 Figure Figure 6.4.3: 6.4.3: Patient Patient Survival Survival by by Type Type of of Homograft, Homograft, 1996-2008 1996-2008.............................. ..............................135 135

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6.0 6.0

INTRODUCTION INTRODUCTION

Valvular Valvularhomografts homograftsare areused usedroutinely routinelyinincardiac cardiacsurgery surgeryespecially especiallyfor forpatients patientswith with congenital congenitalvalvular valvularheart heartdisease. disease.They Theyare areused usedasasbiological biologicalconduits conduitstotoreplace replaceabsent absent valves valvesorortotoreconstruct reconstructoutflow outflowtracks tracksininthe theheart. heart.Homografts Homograftsare aresuperior superiortotoartificial artificial valves valvesdue duetototheir theirinherent inherenttraits traitssuch suchasassuperior superiorperfusion perfusionparameters, parameters,durability, durability,ease ease ofofhandling handlingand andreduced reducedrisk riskofofthrombo-embolic thrombo-embolicphenomenon. phenomenon.This Thisremoves removesthe theneed need for for tight tight anticoagulation anticoagulation treatment treatment post post operatively operatively and and isis extremely extremely convenient convenient for for children children and and women women of of childbearing childbearing age age inin whom whom anticoagulation anticoagulation isis contraindicated. contraindicated. Homografts Homograftshave haveinherent inherentresistance resistancetotoinfection infectionand andare arepreferred preferredininan anenvironment environment where wheresepsis sepsisisisofofconcern. concern. Institut InstitutJantung JantungNegara Negara(IJN) (IJN)established establishedthe thecardiovascular cardiovasculartissue tissuebank bankinin1995. 1995.This This was wasininresponse responsetotothe therising risingneed needfor forhomografts homograftsand andalso alsothe therising risingcost costofofimporting importing homografts homograftsfrom fromoverseas. overseas. The The Homograft Homograft Unit Unit inin IJN IJN comprises comprises of of surgeons surgeons and and medical medical technicians technicians who who are are involved involvedininretrieving, retrieving,processing processingand andcryopreserving cryopreservingthe thehomografts homograftsfor forstorage. storage.The The detailed detailedrecords recordsof ofthe thesize sizeof ofthe thehomografts homograftsare aredocumented. documented.The Theinfective infectivestate stateand and the theserology serologystatus statusofofthe thedonors donorsare arealso alsodocumented. documented. The The outcome outcome ofof patients patients that that had had been been implanted implanted with with homografts homografts has has been been encouraging encouragingand andthese thesepatients patientshave havebeen beenhaving havinggood goodquality qualityofoflife. life. The Thecontinued continuedefforts effortsby bythe theMinistry MinistryofofHealth Healthininpromoting promotingorgan organand andtissue tissuedonation donation have havehelped helpedtotoimprove improvethe theavailability availabilityofofhomografts homograftsininthe thecountry. country.The Theefficient efficientand and better betterstreamlining streamliningofoforganisation organisationstructure structurehas hasimproved improvednetworking networkingbetween betweenvarious various hospitals hospitalsand andtransplant transplantunits unitswith withbetter betterpublic publicand andmedical medicalstaff staffawareness. awareness.

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6.1 STOCK List of TablesAND FLOW Table 6.1.1: Stock and Flow, 1996-2008 ..................................................................... 128 Table 6.2.1: 6.1.1: Distribution Stock and Flow, 1996-2008 Table of Patients by Gender, 1996-2008 ....................................... 129 Year 1996 1997 1998 1999 20021996-2008 2003 2004 ............................. 2005 2006 2007 2008 Table 6.2.2: Distribution of Patients by 2000 Ethnic2001 Group, 130 New transplant 4 32 22 17 13 20 22 21 9 3 4 5 28 Table 6.2.3: Distribution of Patients by Age, 1996-2008 ............................................ 131 Deaths* 1 0 4 3 0 6 4 3 4 2 1 0 3 Table 6.3.1: Number of Valves Harvested by Type of Homograft, 1996-2008 .......... 132 Lost to follow up 0 0 0 0 0 0 0 0 0 0 0 0 0 Table 6.3.2: Type of Transplant, 1996-2008 ............................................................... 132 Alive with Table 6.4.1: Patient Survival by Gender, 1996-2008................................................... 133 3 35 53 67 80 94 112 130 135 136 139 144 168 functioning graft st Table Patient Survival by Age Group, 1996-2008............................................. 134 December at 31 6.4.2: Table Patient Survival by Type of Homograft, 1996-2008 ............................... 135 *based6.4.3: on year of death

Number of patients

List of Figures Figure 128 Figure 6.1.1: 6.1.1: Stock Stock and and Flow, Flow, 1996-2008.................................................................... 1996-2008 Figure 6.2.1: Distribution of Patients by Gender, 1996-2008...................................... 129 New patients Alive at 31st Dec Figure 6.2.2: 180 Distribution of Patients by Ethnic Group, 1996-2008............................ 130 Figure 6.2.3: 170 Distribution of Patients by Age, 1996-2008........................................... 131 160 Type of Transplant, 1996-2008 .............................................................. 132 Figure 6.3.2: 150 Patient Survival by Gender, 1996-2008 ................................................. 133 Figure 6.4.1: 140 Patient Survival by Age Group, 1996-2008 ........................................... 134 Figure 6.4.2: 130 Figure 6.4.3: Patient Survival by Type of Homograft, 1996-2008 .............................. 135 120 110 100 90 80 70 60 50 40 30 20 10 0

1996

1997

1998

1999

2000

2001

2002

Year

128 126

2003

2004

2005

2006

2007

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6.2 6.0RECIPIENTSâ&#x20AC;&#x2122; INTRODUCTION CHARACTERISTICS Table Valvular 6.2.1: homografts Distribution areofused Patients routinely by Gender, in cardiac 1996-2008 surgery especially for patients with Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 conduits 2006 2007 2008 TOTAL congenital valvular heart disease. They are used as biological to replace absent Gender No. No. outflow No. No. No.in No. No. Homografts No. No. No. No. No.to artificial No. valves orNo. to reconstruct tracks the heart. are superior Male 19 inherent 9 9 traits 10 such6 as superior 9 14 perfusion 3 0 parameters, 4 2 durability, 13 100ease valves due2 to their Female 2 13 13 8 3 14 13 7 6 3 0 3 15 of handling and reduced risk of thrombo-embolic phenomenon. This removes the100 need TOTAL 32 22 17 13 20 22 21 9and is 3 extremely 4 5 convenient 28 200 for for tight 4anticoagulation treatment post operatively children and women of childbearing age in whom anticoagulation is contraindicated. Homografts have inherent resistance to infection and are preferred in an environment Figure of Patients by Gender, 1996-2008 where 6.2.1: sepsisDistribution is of concern. Male

Female

Institut 20 Jantung Negara (IJN) established the cardiovascular tissue bank in 1995. This was in response to the rising need for homografts and also the rising cost of importing 18 homografts from overseas. 16

Number

The Homograft Unit in IJN comprises of surgeons and medical technicians who are involved14in retrieving, processing and cryopreserving the homografts for storage. The detailed records of the size of the homografts are documented. The infective state and 12 the serology status of the donors are also documented. 10

The outcome of patients that had been implanted with homografts has been 8 and these patients have been having good quality of life. encouraging 6 The continued efforts by the Ministry of Health in promoting organ and tissue donation have helped 4 to improve the availability of homografts in the country. The efficient and better streamlining of organisation structure has improved networking between various hospitals2and transplant units with better public and medical staff awareness. 0

1996

1997

1998

1999

2000

2002

2001

Year

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2003

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Table Distribution of Patients by Ethnic Group, 1996-2008 List of6.2.2: Tables Year 6.1.1: Stock 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 TOTAL Table and Flow, 1996-2008 ..................................................................... 128 Ethnic6.2.1: Distribution of Patients by Gender, 1996-2008 ....................................... 129 Table No. No. No. No. No. No. No. No. No. No. No. No. No. No. group6.2.2: Distribution of Patients by Ethnic Group, 1996-2008 ............................. 130 Table Malay 1 19 15 9 9 10 16 12 3 2 3 18 123 Table 6.2.3: Distribution of Patients by Age, 1996-2008 6............................................ 131 Chinese 3 11 4 3 2 9 4 6 1 0 1 0 7 51 Table 6.3.1: Number of Valves Harvested by Type of Homograft, 1996-2008 .......... 132 Indian 0 2 2 2 0 1 2 2 1 0 1 0 1 14 Table 6.3.2: Type of0 Transplant, 1996-2008 ............................................................... 132 Others 0 1 3 2 0 0 1 1 0 0 2 2 12 Table 6.4.1: Patient Survival by Gender, 1996-2008................................................... 133 TOTAL 4 32 22 17 13 20 22 21 9 3 4 5 28 200 Table 6.4.2: Patient Survival by Age Group, 1996-2008............................................. 134 Table 6.4.3: Patient Survival by Type of Homograft, 1996-2008 ............................... 135

Number

Figure 6.2.2: Distribution of Patients by Ethnic Group, 1996-2008 List of Figures Malay Chinese Figure 6.1.1: Stock and Flow, 1996-2008.................................................................... 128 Indian Others Figure 6.2.1: Distribution of Patients by Gender, 1996-2008...................................... 129 20 Figure 6.2.2: Distribution of Patients by Ethnic Group, 1996-2008............................ 130 18 Distribution of Patients by Age, 1996-2008........................................... 131 Figure 6.2.3: Figure 6.3.2: 16 Type of Transplant, 1996-2008 .............................................................. 132 Figure 6.4.1: Patient Survival by Gender, 1996-2008 ................................................. 133 14 Patient Survival by Age Group, 1996-2008 ........................................... 134 Figure 6.4.2: Figure 6.4.3: Patient Survival by Type of Homograft, 1996-2008 .............................. 135 12 10 8 6 4 2 0

1996

1997

1998

1999

2000

2001

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Year

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Table Distribution of Patients by Age, 1996-2008 6.0 6.2.3: INTRODUCTION

Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 TOTAL Age No. No. No. No. No. inNo. No. surgery No. No. especially No. No. for No. ValvularNo. homografts are used routinely cardiac patientsNo. with group congenital valvular heart disease. They are used as biological conduits to replace absent 0-9 2 15 15 12 10 14 10 11 3 1 3 2 19 117 valves or1to reconstruct 10-19 13 5 outflow 5 2tracks2 in the 10 heart. 8 Homografts 4 0 1 are superior 2 7 to artificial 60 valves due inherent 20-39 1 to their 4 1 0traits0 such3as superior 2 1 perfusion 1 2 parameters, 0 0 durability, 2 17ease of handling 40-59 0 and 0 reduced 0 risk 0 of 0thrombo-embolic 1 0 1 phenomenon. 1 0 0 This1 removes 0 the 4need 60 0 1 0 1 0 operatively 0 0 0 and0is extremely 0 0 0 2 for for tight 0anticoagulation treatment post convenient TOTAL 4 32 22 17 13 20 22 21 9 3 4 5 28 200 children and women of childbearing age in whom anticoagulation is contraindicated. Mean 12 have 11 inherent 11 7resistance 12 11 10 12 and 15 are15preferred 6 16in an environment 7 11 Homografts to infection SD 7 7 15 4 17 14 6 11 11 8 5 18 6 10 where sepsis is10of concern. Median 11 8 7 8 5 10 9 10 20 5 11 7 8 5 4 1 1 Min 3 3 5 1 2 3 2 5 6 1 Institut Jantung Negara bankmonths in 1995. This months the cardiovascular tissue months months months months(IJN) established Max 21 30 to the 70 rising 17 need 67 for53homografts 28 53 and 42 also 20 the12rising 47 cost 21 70 was in response of importing

*homografts Age=date of implantation from overseas. – date of birth

The Homograft Unit in IJN comprises of surgeons and medical technicians who are Figure 6.2.3: Distributionprocessing of Patientsand by cryopreserving Age, 1996-2008the homografts for storage. The involved in retrieving, 10-19are years years state and detailed records 0-9 of years the size of the homografts documented. The 20-39 infective 40-59 years 60 years the serology status of the donors are also documented. 20

The outcome of patients that had been implanted with homografts has been 18 encouraging and these patients have been having good quality of life. 16

Number

The continued efforts by the Ministry of Health in promoting organ and tissue donation 14 to improve the availability of homografts in the country. The efficient and have helped better streamlining of organisation structure has improved networking between various hospitals12and transplant units with better public and medical staff awareness. 10 8 6 4 2 0

1996

1997

1998

1999

2000

2001

131 127

2002

Year

2003

2004

2005

2006

2007

2008

HOMOGRAFT HOMOGRAFT -- HEART HEART VALVE VALVE TRANSPLANTATION TRANSPLANTATION

Fifth Report ofthe the Fifth Fifth Report Report of of the National Transplant 2008 National National Transplant TransplantRegistry Registry Registry2008 2008

List 6.3 TRANSPLANT of Tables PRACTICES Table 6.1.1: Stock and Flow, 1996-2008 ..................................................................... 128 Table 6.3.1 Donor 6.2.1: Distribution Details of Patients by Gender, 1996-2008 ....................................... 129 Table 6.2.2: Distribution of Patients by Ethnic Group, 1996-2008 ............................. 130 Table Table 6.2.3: 6.3.1: Distribution Number of Valves of Patients Harvested by Age, by1996-2008 Type of Homograft, ............................................ 1996-2008 131 Year 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 TOTAL Table 6.3.1: Number of Valves Harvested by Type of Homograft, 1996-2008 .......... 132 Type of Table 6.3.2: Type of Transplant, ............................................................... 132 No. No. No. No. 1996-2008 No. No. No. No. No. No. No. No. No. No. homograft Table 6.4.1: Patient Survival by Gender, 1996-2008................................................... 133 Aortic 8 17 10 8 11 14 10 8 7 5 14 9 15 136 Table 6.4.2: Patient by Age 1996-2008............................................. 134 Pulmonary 1 14Survival 11 10 12 Group, 12 14 9 8 5 15 8 13 132 Table 6.4.3: Patient Survival by Type of Homograft, 1996-2008 ............................... 135 TOTAL 9 31 21 18 23 26 24 17 15 10 29 17 28 268 List of Figures Figure 6.1.1: Stock and Flow, 1996-2008.................................................................... 128 6.3.2 Transplant Details Figure 6.2.1: Distribution of Patients by Gender, 1996-2008...................................... 129 Figure 6.2.2: Type Distribution of Patients by Ethnic Group, 1996-2008............................ 130 Table 6.3.2: of Transplant, 1996-2008 Figure Distribution Patients Age, 1996-2008........................................... 131 Year 6.2.3: 1996 1997 1998 of 1999 2000 by 2001 2002 2003 2004 2005 2006 2007 2008 TOTAL Type of6.3.2: Type of Transplant, 1996-2008 .............................................................. 132 Figure No. No. No. No. No. No. No. No. No. No. No. No. No. No. transplant Figure 6.4.1: Patient Survival by Gender, 1996-2008 ................................................. 133 Aortic 6.4.2:4Patient 19 Survival 11 7 by Age 7 Group, 9 101996-2008 10 4 ........................................... 1 1 2 8 93134 Figure Pulmonary 0 13 11 10 6 11 12 11 5 2 3 3 20 107 Figure 6.4.3:4Patient Survival by Type of Homograft, 1996-2008 .............................. 135 TOTAL 32 22 17 13 20 22 21 9 3 4 5 28 200 Figure 6.3.2: Type of Transplant, 1996-2008 Aortic

Pulmonary

22 20 18

Number

16 14 12 10 8 6 4 2 0

1996

1997

1998

1999

2000

2001

126 132

2002

Year

2003

2004

2005

2006

2007

2008

HOMOGRAFT HOMOGRAFT- -HEART HEARTVALVE VALVE TRANSPLANTATION TRANSPLANTATION

Fifth Report the Fifth FifthReport Reportofof ofthe the National Transplant Registry 2008 National NationalTransplant TransplantRegistry Registry 2008 2008

6.4 6.0TRANSPLANT INTRODUCTION OUTCOMES Table Valvular 6.4.1: homografts Patient Survival are used by routinely Gender, 1996-2008 in cardiac surgery especially for patients with Gender Male Female to replace absent congenital valvular heart disease. They are used as biological conduits Interval (years) % Survival SE % Survival SE to artificial valves or to reconstruct outflow tracks in the heart. Homografts are superior 1 92 3 89 3 valves due to their inherent traits such as superior perfusion parameters, durability, ease 3 89 3 86 4 of handling and reduced risk of thrombo-embolic phenomenon. This removes the need 5 87 4 86 4 for tight anticoagulation treatment post operatively and is extremely convenient for SE=standard error children and women of childbearing age in whom anticoagulation is contraindicated. Homografts have inherent resistance to infection and are preferred in an environment where 6.4.1: sepsisPatient is of concern. Figure Survival by Gender, 1996-2008 Institut 1.00 Jantung Negara (IJN) established the cardiovascular tissue bank in 1995. This was in response to the rising need for homografts and also the rising cost of importing homografts from overseas. Cumulative survival

The0.75 Homograft Unit in IJN comprises of surgeons and medical technicians who are involved in retrieving, processing and cryopreserving the homografts for storage. The detailed records of the size of the homografts are documented. The infective state and the serology status of the donors are also documented. 0.50

The outcome of patients that had been implanted with homografts has been encouraging and these patients have been having good quality of life. 0.25

The continued efforts by the Ministry of Health in promoting organ and tissue donation have helped to improve the availability of homografts in the country. The efficient and better streamlining of organisation structure has improved networking between various 0.00 and transplant units with better public and medical staff awareness. hospitals 0

2 3 Duration in years Female

133 127

4 Male

HOMOGRAFT HOMOGRAFT -- HEART HEART VALVE VALVE TRANSPLANTATION TRANSPLANTATION

Fifth Report ofthe the Fifth Fifth Report Report of of the National Transplant 2008 National National Transplant TransplantRegistry Registry Registry 2008 2008

Table Patient Survival by Age Group, 1996-2008 List of6.4.2: Tables Age group years 10-19 years 20 years 128 Table 6.1.1: Stock and Flow,0-9 1996-2008 ..................................................................... Interval (months) % Survival SE % Survival SE % Survival Table 6.2.1: Distribution of Patients by Gender, 1996-2008 ....................................... SE 129 1 88 3 97 2 85 8 Table 6.2.2: Distribution of Patients by Ethnic Group, 1996-2008 ............................. 130 3 87 3 91 4 80 9 Table 6.2.3: Distribution of87Patients by 3Age, 1996-2008 ............................................ 131 5 89 4 74 10 Table 6.3.1: Number SE=standard error of Valves Harvested by Type of Homograft, 1996-2008 .......... 132 Table 6.3.2: Type of Transplant, 1996-2008 ............................................................... 132 Table 6.4.1: Patient Survival by Gender, 1996-2008................................................... 133 Table 134 Figure6.4.2: 6.4.2:Patient PatientSurvival Survivalby byAge AgeGroup, Group,1996-2008............................................. 1996-2008 Table 6.4.3: Patient Survival by Type of Homograft, 1996-2008 ............................... 135 1.00

Cumulative survival

List of Figures Figure 6.1.1: Stock and Flow, 1996-2008.................................................................... 128 Figure 6.2.1: Distribution of Patients by Gender, 1996-2008...................................... 129 0.75 Figure 6.2.2: Distribution of Patients by Ethnic Group, 1996-2008............................ 130 Figure 6.2.3: Distribution of Patients by Age, 1996-2008........................................... 131 Figure 6.3.2: Type of Transplant, 1996-2008 .............................................................. 132 Figure 6.4.1: Patient Survival by Gender, 1996-2008 ................................................. 133 0.50 Figure 6.4.2: Patient Survival by Age Group, 1996-2008 ........................................... 134 Figure 6.4.3: Patient Survival by Type of Homograft, 1996-2008 .............................. 135 0.25

0.00 0

2 3 Duration in years 0-9 years 20 years

126 134

4 10-19 years

HOMOGRAFT HOMOGRAFT- -HEART HEARTVALVE VALVE TRANSPLANTATION TRANSPLANTATION

Fifth Report the Fifth FifthReport Reportofof ofthe the National Transplant Registry 2008 National 2008 NationalTransplant TransplantRegistry Registry 2008

Table Patient Survival by Type of Homograft, 1996-2008 6.0 6.4.3: INTRODUCTION

Type of homograft Aortic Pulmonary Interval (years) % Survival SE % Survival SE with Valvular homografts are used routinely in cardiac surgery especially for patients 1 90 3 91 3 congenital valvular heart disease. They are used as biological conduits to replace absent 3 85 4 90 3 valves or5 to reconstruct outflow tracks in the heart. Homografts are superior to artificial 84 4 89 3

valves due toerror their inherent traits such as superior perfusion parameters, durability, ease SE=standard of handling and reduced risk of thrombo-embolic phenomenon. This removes the need for tight anticoagulation treatment post operatively and is extremely convenient for children andPatient womenSurvival of childbearing ageHomograft, in whom anticoagulation is contraindicated. Figure 6.4.3: by Type of 1996-2008 Homografts have inherent resistance to infection and are preferred in an environment where 1.00sepsis is of concern.

Cumulative survival

Institut Jantung Negara (IJN) established the cardiovascular tissue bank in 1995. This was in response to the rising need for homografts and also the rising cost of importing 0.75 homografts from overseas. The Homograft Unit in IJN comprises of surgeons and medical technicians who are involved in retrieving, processing and cryopreserving the homografts for storage. The 0.50 detailed records of the size of the homografts are documented. The infective state and the serology status of the donors are also documented. The0.25 outcome of patients that had been implanted with homografts has been encouraging and these patients have been having good quality of life. The continued efforts by the Ministry of Health in promoting organ and tissue donation 0.00 have helped to improve the availability of homografts in the country. The efficient and better streamlining of organisation structure has improved networking between 0 1 2 3 4 5 various Duration in years hospitals and transplant units with better public and medical staff awareness. Aortic

Pulmonary

135 127

CHAPTER 7 BONE AND TISSUE TRANSPLANTATION Editor: Assoc Prof Dr Suzina Sheikh Ab Hamid Expert Panel: Assoc Prof Dr Suzina Sheikh Ab Hamid (Chairperson) Dr Abdul Malik Mohamed Hussein Assoc Prof Dr Ahmad Hafiz Zulkifly Dr Thiageswari Umapathy Dr Ewe Teong Wan Assoc Prof Dr Vivek Ajit Singh Dr Norimah Yusof

Contents 7.0 Introduction 7.1 Stock of Tissue Allografts and Hospitals Where Tissues are Utilised from 2004 to 2008 7.2 Reporting Centres 7.3 Recipient Details 7.4 Pre Transplant Data 7.5 Transplant Surgery Data

BONE BONE AND AND TISSUE TISSUE TRANSPLANTATION TRANSPLANTATION

Fifth Fifth Report of the FifthReport Reportof ofthe the National Transplant Registry 2008 National National Transplant Transplant Registry Registry 2008 2008

7.1 STOCK OF TISSUE ALLOGRAFTS AND HOSPITALS WHERE TISSUES List Tables AREofUTILISED FROM 2004 TO 2008 Table 7.1.1: Types of Tissue Allografts Supplied by USM Tissue Bank, 2004-2008. 139 Table 7.1.2: Using andthat Skinwere Allografts Provided In 2008 andHospitals/Other in the previous Sectors years, the mainBone, tissueTendon allografts distributed were USM Tissue Bank, 2004-2008 ............................................................. 140 by amniotic membranes and deep-frozen femoral heads (Table 7.1.1). USM Tissue Bank Table 7.1.3: Hospitals/Other Sectors UsingofAmniotic Membranes provided by USM provided tissue allografts to the Ministry Health hospitals, private hospitals and other Tissue 2004-2008 ........................................................................... 141 sectors (Table 7.1.2Bank, and 7.1.3). Table 7.2.1: Distribution of Reporting Centre, 2004-2008 .......................................... 142 Table 7.3.1: 7.1.1 Types of Tissue Allografts Supplied bybyUSM Tissue Bank, 2004-2008 Table Distribution of Number of Transplant Gender, 2004-2008 ................ 143 Table 7.3.2: Distribution of Number of Transplant by Ethnic No. of Group, pieces 2004-2008 ...... 143 Types of Tissue Allograft Table 7.3.3: Distribution of Number of Transplant by2006 Age Group, 143 2004 2005 20072004-2008 2008 .......... Total Table 7.3.4: Bone Distribution of Number of Transplant by Diagnosis Warranting Tissue Deep Frozen Knee Slices Graft, 2004-2008 ...................................................................................... 1 0 0 0 0 1144 Femur 7.4.1: Distribution of Number9of Transplantation 7 5 according 2 to Tissue 7 Provider, 30 Table Femoral Head2004-2008 ................................................................................................. 50 88 75 65 54 332 145 Humerus 3 0 by Origin 2 of Tissue 2 Graft, 8 Table 7.4.2: Distribution of Number1of Transplantation Tibia 6 1 4 4 8 23 2004-2008 ................................................................................................. 145 Radius 7.4.3: Distribution of Number1of Transplantation 2 1 by Tissue 0 Graft Types, 3 7 Table 2004Ulna 0 3 0 0 0 3145 2008 .......................................................................................................... Patella/ Bone-Patella-Bone 1 1 4 2 7 15 Table 7.4.3(a) Distribution of Tissue Graft Types (breakdowns), 2004-2008.............146 Others 7.4.4: (Type not stated) 3 0 Types, 2004-2008 0 0.............................. 0 3146 Table Distribution of Graft Sterilization Deep Frozen Tendon Table 7.4.5: Distribution of Mode of Transport Storage to Recipient Hospital during Achilles Tendon 0 0 0 2 1 3 Transportation, 2004-2008 ....................................................................... 146 Quadriceps Tendon 0 0 0 0 5 5 Table 7.4.6: Distribution of Temperature of Storage during Transportation, 2004-2008 Others (Type not stated) 0 0 1 3 3 7 .................................................................................................................. 147 Freeze Dried Bone Table 7.5.1: Distribution of Mode of Storage in Recipient Hospital, 2004-2008........ 148 Cancellous chip 17 19 37 2 27 102 Table 7.5.2: Distribution of Additional Tissue Usage (Composite Graft), 2004-2008 148 Cortical 2 0 0 0 0 2 Table 7.5.3: Distribution of Presence5 of Pre Operative Infection 0at Implant0 Site, 2004Cortico-cancellous 2 0 7 2008 .......................................................................................................... Others (Type not stated) 0 0 0 8 0 8148 Table Skin 7.5.4: Distribution of Pre Implant Graft Cultural Swab, 2004-2008 ................. 149 Table 7.5.5:Skin Distribution of Grafts Soaked in0Antibiotics Deep Frozen 0 0 Prior to0 Transplantation, 36 36 2004-2008 ................................................................................................. 149 Amniotic membrane Table 7.5.6: Distribution of Number of Transplant by379 Systemic175 Antibiotics Prior Air-dried & Glycerol Preserved 1128 64 2081Given 3827 to Transplantation, 2004-2008 .................................................................. 150 Total 1224 190 506 265 2234 4419

137 139

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BONE BONEAND ANDTISSUE TISSUETRANSPLANTATION TRANSPLANTATION

Table 7.1.2 Hospitals/Other Sectors Using Bone, Tendon and Skin Allografts Provided 7.0 INTRODUCTION by USM Tissue Bank, 2004-2008 No. of pieces

Recipients

2004 2005 that 2006 2008 Total The first part of this chapter presents data on tissue allografts have2007 been distributed MOH and data about recipient centres. These data were provided by Universiti Sains Hospital Sultanah Bahiyah, Alor Setar 1 10 6 2 0 19 Malaysia (USM) Tissue Bank as the bank involves in13human Hospital Umum Sarawak, Kuching 3 10 tissue 6 procurement, 3 35 processing, are4 other 9centres/hospitals that Hospital Ipoh storage and distribution. However, there 0 3 0 16 Hospital Kemaman 0 0 10 0 0 10 participated in these activities but did not report to NTR.

Hospital Sultanah Nurzahirah, Kuala Terengganu 0 0 2 0 0 2 Hospital Melaka 1 0 0 3 0 4 The second part presents data obtained from 5the Bone and Transplant Hospital Pulau Pinang 1 7 Tissue 7 0 20 Queen Elizabeth Hospital, Kota Kinabalu 0 is tabulated 12 2 from 02004 to 14 Notification Form submitted by surgeons to NTR.0The data Hospital Raja Perempuan Zainab II, Kota Bharu 5 2 1 0 8 16 2008 to identify the trend of tissue transplant activities. The notification is still very Hospital Seberang Jaya, Pulau Pinang 0 2 0 3 0 5 poor andSelayang the limited data has restricted further analysis and0 definitive conclusions Hospital 0 3 0 0 could 3 not be made. Hospital Seremban 2 2 1 0 0 5 Hospital Sultanah Aminah, Johor Bahru 9 19 11 1 0 40 Hospital Sultan Ismail,does Johor not Bahrureflect the actual magnitude 0 0of human 0 2 73 75 Thus, the report tissue supply and Hospital Tengku Ampuan Afzan, Kuantan 0 1 2 0 0 3 transplant activity inRahimah, the country. The deficiency0 would and Hospital Tengku Ampuan Klang 5 affect 0 the 0evaluation 0 5 planning of the tissue transplant programme and service by and Hospital Muar 0 0 the Ministry 0 0 of Health 2 2 Total 26 59 74 29 86 274 other organisations. University Hospitals

Aggressive and continuous effort has to be made that of tissue HUSM 39 to ensure 23 30 all 3cases 20 115 HUKM transplantation are reported. In addition, 3the Ministry 2 3 Health 5 has 0to make 13 allograft of UMMC 9 3 0 0 0 12 new initiatives to enforce notification to NTR by other centres/hospitals that are Total 51 28 33 8 20 140 involved in tissue allograft provision. Private and other sectors Amin Dental Surgery, Johor Bahru Antal Rastu Sdn Bhd Borneo Indah Sdn. Bhd. Chong Dental Surgery, Seri Kembangan Selangor Hospital Fatimah, Ipoh Pantai Medical Centre, Air Keroh Mahkota Medical Centre, Melaka Hospital Tawakal, KL Hospital Tung Shin, Kuala Lumpur Jasa Dental Surgery, Kuala Lumpur Johnson & Johnson Medical Kemajuan Abadi Sdn. Bhd. Klinik Pergigian Chong, Tangkak, Johor Kota Bahru Medical Centre, Kota Bharu Lam Wah Ee Hospital, Pulau Pinang Normah Medical Center, Kuching Pantai Medical Center, Bangsar Island Hospital, Pulau Pinang Sentosa Medical Centre, Kuala Lumpur Sri Kota Medical Centre, Klang Stryker Sunway Medical Centre, Selangor Teo Orthopaedic, Kuala Lumpur Zimmer Kuching Specialist Hospital, Sarawak Total

0 0 0 0 1 0 0 0 0 5 0 0 0 0 0 0 0 0 0 2 2 0 0 9 0 19

0 0 0 0 12 0 2 0 2 0 0 5 0 0 0 0 0 0 1 0 4 0 10 3 0 39

0 2 0 0 0 5 1 0 0 0 0 0 0 2 3 0 0 0 0 0 6 1 0 0 0 20

5 0 0 1 2 0 0 3 0 0 2 2 1 0 0 3 1 0 0 0 12 0 0 21 0 53

0 0 4 0 11 0 0 9 0 0 16 0 0 0 0 3 0 1 0 0 20 0 0 18 1 83

5 2 4 1 26 5 3 12 2 5 18 7 1 2 3 6 1 1 1 2 44 1 10 51 1 214

Grand Total

126

127

189

628

138 140

Fifth Fifth Report of the FifthReport Reportof ofthe the National Transplant Registry 2008 National National Transplant Transplant Registry Registry 2008 2008

BONE BONE AND AND TISSUE TISSUE TRANSPLANTATION TRANSPLANTATION

7.1 7.1 STOCK STOCK OF OF TISSUE TISSUE ALLOGRAFTS ALLOGRAFTS AND AND HOSPITALS HOSPITALS WHERE WHERE TISSUES TISSUES ARE ARE UTILISED UTILISED FROM FROM 2004 2004 TO TO 2008 2008 In In 2008 2008 and and in in the the previous previous years, years, the the main main tissue tissue allografts allografts that that were were distributed distributed were were amniotic membranes and deep-frozen femoral heads (Table 7.1.1). USM Tissue Bank amniotic membranes and deep-frozen femoral heads (Table 7.1.1). USM Tissue Bank provided provided tissue tissue allografts allografts to to the the Ministry Ministry of of Health Health hospitals, hospitals, private private hospitals hospitals and and other other sectors sectors (Table (Table 7.1.2 7.1.2 and and 7.1.3). 7.1.3). Table Table 7.1.1 7.1.1 Types Types of of Tissue Tissue Allografts Allografts Supplied Supplied by by USM USM Tissue Tissue Bank, Bank, 2004-2008 2004-2008 Types Types of of Tissue Tissue Allograft Allograft Deep Deep Frozen Frozen Bone Bone Knee Knee Slices Slices Femur Femur Femoral Femoral Head Head Humerus Humerus Tibia Tibia Radius Radius Ulna Ulna Patella/ Patella/ Bone-Patella-Bone Bone-Patella-Bone Others (Type Others (Type not not stated) stated) Deep Frozen Tendon Deep Frozen Tendon Achilles Achilles Tendon Tendon Quadriceps Quadriceps Tendon Tendon Others (Type Others (Type not not stated) stated) Freeze Freeze Dried Dried Bone Bone Cancellous Cancellous chip chip Cortical Cortical Cortico-cancellous Cortico-cancellous Others Others (Type (Type not not stated) stated) Skin Skin Deep Deep Frozen Frozen Skin Skin Amniotic Amniotic membrane membrane Air-dried Air-dried & & Glycerol Glycerol Preserved Preserved Total Total

No. No. of of pieces pieces 2006 2007 2006 2007

2004 2004

2005 2005

2008 2008

Total Total

11 99 50 50 11 66 11 00 11 33

00 77 88 88 33 11 22 33 11 00

00 55 75 75 00 44 11 00 44 00

00 22 65 65 22 44 00 00 22 00

00 77 54 54 22 88 33 00 77 00

11 30 30 332 332 88 23 23 77 33 15 15 33

00 00 00

00 00 11

22 00 33

11 55 33

33 55 77

17 17 22 55 00

19 19 00 22 00

37 37 00 00 00

22 00 00 88

27 27 00 00 00

102 102 22 77 88

36 36

1128 1128 1224 1224

64 64 190 190

379 379 506 506

175 175 265 265

2081 2081 2234 2234

3827 3827 4419 4419

139 139

Fifth Report of the Fifth Report the Fifth Report ofof the National Transplant Registry 2008 NationalTransplant Transplant Registry 2008 National Registry 2008

BONE BONEAND ANDTISSUE TISSUETRANSPLANTATION TRANSPLANTATION

Table Table7.1.2 7.1.2Hospitals/Other Hospitals/OtherSectors SectorsUsing UsingBone, Bone,Tendon Tendonand andSkin SkinAllografts AllograftsProvided Provided bybyUSM USMTissue TissueBank, Bank,2004-2008 2004-2008

No. of of pieces No. pieces 2004 2004 2005 2005 2006 2006 2007 2007 2008 2008 Total Total

Recipients Recipients MOH MOH Hospital Sultanah Bahiyah, Alor Setar Hospital Sultanah Bahiyah, Alor Setar Hospital Umum Sarawak, Kuching Hospital Umum Sarawak, Kuching Hospital Ipoh Hospital Ipoh Hospital Kemaman Hospital Kemaman Hospital Sultanah Nurzahirah, Kuala Terengganu Hospital Sultanah Nurzahirah, Kuala Terengganu Hospital Melaka Hospital Melaka Hospital Pulau Pinang Hospital Pulau Pinang Queen Elizabeth Hospital, Kota Kinabalu Queen Elizabeth Hospital, Kota Kinabalu Hospital Raja Perempuan Zainab II,II, Kota Bharu Hospital Raja Perempuan Zainab Kota Bharu Hospital Seberang Jaya, Pulau Pinang Hospital Seberang Jaya, Pulau Pinang Hospital Selayang Hospital Selayang Hospital Seremban Hospital Seremban Hospital Sultanah Aminah, Johor Bahru Hospital Sultanah Aminah, Johor Bahru Hospital Sultan Ismail, Johor Bahru Hospital Sultan Ismail, Johor Bahru Hospital Tengku Ampuan Afzan, Kuantan Hospital Tengku Ampuan Afzan, Kuantan Hospital Tengku Ampuan Rahimah, Klang Hospital Tengku Ampuan Rahimah, Klang Hospital Muar Hospital Muar Total Total

11 33 00 00 00 11 55 00 55 00 00 22 99 00 00 00 00 2626

1010 1313 44 00 00 00 11 00 22 22 00 22 1919 00 11 55 00 5959

66 1010 99 1010 22 00 77 1212 11 00 33 11 1111 00 22 00 00 7474

22 66 33 00 00 33 77 22 00 33 00 00 11 22 00 00 00 2929

00 33 00 00 00 00 00 00 88 00 00 00 00 7373 00 00 22 8686

1919 3535 1616 1010 22 44 2020 1414 1616 55 33 55 4040 7575 33 55 22 274 274

University Hospitals University Hospitals HUSM HUSM HUKM HUKM UMMC UMMC Total Total

3939 33 99 5151

2323 22 33 2828

3030 33 00 3333

3 5 0 8

2020 00 00 2020

115 115 1313 1212 140 140

Private and other sectors Private and other sectors Amin Dental Surgery, Johor Bahru Amin Dental Surgery, Johor Bahru Antal Rastu Sdn Bhd Antal Rastu Sdn Bhd Borneo Indah Sdn. Bhd. Borneo Indah Sdn. Bhd. Chong Dental Surgery, Seri Kembangan Selangor Chong Dental Surgery, Seri Kembangan Selangor Hospital Fatimah, Ipoh Hospital Fatimah, Ipoh Pantai Medical Centre, AirAir Keroh Pantai Medical Centre, Keroh Mahkota Medical Centre, Melaka Mahkota Medical Centre, Melaka Hospital Tawakal, KLKL Hospital Tawakal, Hospital Tung Shin, Kuala Lumpur Hospital Tung Shin, Kuala Lumpur Jasa Dental Surgery, Kuala Lumpur Jasa Dental Surgery, Kuala Lumpur Johnson && Johnson Medical Johnson Johnson Medical Kemajuan Abadi Sdn. Bhd. Kemajuan Abadi Sdn. Bhd. Klinik Pergigian Chong, Tangkak, Johor Klinik Pergigian Chong, Tangkak, Johor Kota Bahru Medical Centre, Kota Bharu Kota Bahru Medical Centre, Kota Bharu Lam Wah EeEe Hospital, Pulau Pinang Lam Wah Hospital, Pulau Pinang Normah Medical Center, Kuching Normah Medical Center, Kuching Pantai Medical Center, Bangsar Pantai Medical Center, Bangsar Island Hospital, Pulau Pinang Island Hospital, Pulau Pinang Sentosa Medical Centre, Kuala Lumpur Sentosa Medical Centre, Kuala Lumpur SriSri Kota Medical Centre, Klang Kota Medical Centre, Klang Stryker Stryker Sunway Medical Centre, Selangor Sunway Medical Centre, Selangor Teo Orthopaedic, Kuala Lumpur Teo Orthopaedic, Kuala Lumpur Zimmer Zimmer Kuching Specialist Hospital, Sarawak Kuching Specialist Hospital, Sarawak Total Total

00 00 00 00 11 00 00 00 00 55 00 00 00 00 00 00 00 00 00 22 22 00 00 99 00 1919

00 00 00 00 1212 00 22 00 22 00 00 55 00 00 00 00 00 00 11 00 44 00 1010 33 00 3939

00 22 00 00 00 55 11 00 00 00 00 00 00 22 33 00 00 00 00 00 66 11 00 00 00 2020

55 00 00 11 22 00 00 33 00 00 22 22 11 00 00 33 11 00 00 00 1212 00 00 2121 00 5353

00 00 44 00 1111 00 00 99 00 00 1616 00 00 00 00 33 00 11 00 00 2020 00 00 1818 11 8383

55 22 44 11 2626 55 33 1212 22 55 1818 77 11 22 33 66 11 11 11 22 4444 11 1010 5151 11 214 214

Grand Total Grand Total

9696

126 126

127 127

9090

189 189

628 628

140 140

Fifth Fifth Report of the FifthReport Reportof ofthe the National Transplant Registry 2008 National National Transplant Transplant Registry Registry 2008 2008

BONE BONE AND AND TISSUE TISSUE TRANSPLANTATION TRANSPLANTATION

7.1 STOCK OF TISSUE ALLOGRAFTS AND HOSPITALS WHERE TISSUES Table Hospitals/Other Sectors ARE 7.1.3 UTILISED FROM 2004 TOUsing 2008 Amniotic Membranes provided by USM Tissue Bank, 2004-2008 No. of pieces In 2008 and in the previous years, the main tissue allografts that were distributed were Recipients 2004 2005 2006 2007 2008 Total amniotic membranes and deep-frozen femoral heads (Table 7.1.1). USM Tissue Bank Ministry of Health provided private hospitals Hospital Miri,tissue Sabah allografts to the Ministry of Health 0 hospitals, 0 0 5 10and other 15 Hospital Lumpur 22 15 13 40 0 90 sectorsKuala (Table 7.1.2 and 7.1.3). Hospital Sultanah Bahiyah, Alor Setar Hospital Umum Sarawak, Kuching Table 7.1.1 Types of Tissue Allografts Hospital Sultanah Nurzahirah, Kuala Terengganu Hospital Melaka Types of Tissue Allograft Hospital Pakar Sultanah Fatimah, Johor Bahru2004 Hospital Pulau Pinang Deep Frozen Bone Queen Elizabeth Hospital, Kota Kinabalu Knee Slices Hospital Raja Perempuan Zainab II, Kota Bharu1 Femur 9 Hospital Selayang Hospital Sultanah Aminah, Johor Bahru Femoral Head 50 Hospital Sultan Ismail, Johor Bahru Humerus 1 Hospital Teluk Intan Tibia 6 Hospital Tengku Ampuan Afzan, Kuantan Radius Tengku Ampuan Rahimah, Klang 1 Hospital Hospital Ulna Kuala Krai 0 Hospital Buloh Patella/ Sungai Bone-Patella-Bone 1 Total

0 0 2 7 0 9 6 10 0 6 1 23 Supplied by USM1 Tissue0 Bank,5 2004-2008 0 0 6 5 5 of pieces 10 0 5 25 No. 100 0 2008 0 100 2005 0 20060 2007 Total 0 0 0 3 0 3 0 0 4 1 0 5 0 0 5 18 0 00 2 0 1 7 5 0 301 0 12 0 7 0 73 0 200 0 0 273 88 75 65 54 332 0 0 0 50 0 3 0 2 2 850 0 0 1 4 0 5 1 4 6 4 8 2319 6 7 0 0 2 1 5 79 4 00 0 3 0 0 0 0 0 1 3 0 0 31 0 02 21 7 40 1 4 0 1561 116 47 338 144 58 703

Others (Type not stated) 3 0 0 Deep Frozen Tendon University Hospitals Achilles Tendon 0 0 1001 0 1 HUSM HUKM 4 Quadriceps Tendon 0 0 0 0 UMMC 5 Others (Type not stated) 0 0 1 0 IIUM 0 0 Freeze Dried Bone Total 1010 1 Cancellous chip 17 19 37 Corticaland other sectors 2 0 0 Private Gleneagles Medical Centre, Pulau Pinang 2 Cortico-cancellous 5 2 0 4 Hospita Mata Tun Hussein Onn 0 Others (Type not stated) 0 0 0 4 Hospital Tawakal, KL 0 0 SkinSdn. Bhd. ISEC 0 0 Deep Iman, Frozen Skin 0 0 0 1 Klinik Seremban 0 Kuala Terengganu Specialist Center, Kuala Terengganu 0 0 Amniotic membrane Peter Kong Eye Clinic, Kota Kinabalu 0 Air-dried & Glycerol Preserved 1128 64 379 0 Pusat Rawatan Islam Al-Zahirah, Bangi, Selangor 0 0 Total 1224 190 506 5 Puteri Specialist Hospital, Johor Bahru 0 Putra Medical Centre, Alor Setar Sri Kota Medical Centre, Klang CryoCord Sdn. Bhd. Total Grand Total

141 139

82 0 63 0 14

7 1 7 5 0 3 6 20

6 5 0 0 4 2 0 2 361 0 36 0 3 0 3 0 2081 2 2 3827 0 0 10 2234 0 4419 5 10 1 0 2 0 2 8 0 2081 2081 11 2096 2152 175

2 0 80 0 8

0 0 0 2

0 2 0 16

4 0 00 0 0 175 10 265 0 1 4 0 27

1128

379

27 0 0 0 0 0

4 32 5 0 41

2195

3 1021 543 716 6 1086

102 2 720 89

3941

Fifth Report of the Fifth Report the Fifth Report ofof the National Transplant Registry 2008 NationalTransplant Transplant Registry 2008 National Registry 2008

BONE BONEAND ANDTISSUE TISSUETRANSPLANTATION TRANSPLANTATION

7.2 Reporting Centre Table 7.1.2 Hospitals/Other Sectors Using Bone, Tendon and Skin Allografts Provided by USM Tissue Bank, 2004-2008 No. of pieces The recipient centres that reported to the National Transplant Registry using the Bone Recipients 2004 2005 2006 2007 2008 Total and Tissue Transplant Notification Form are shown on Table 7.2.1. The total number of MOH reporting centres in 2008 has decreased compared to previous years. Hospital Sultanah Bahiyah, Alor Setar 1 10 6 2 0 19 Hospital Umum Sarawak, Kuching

Hospital IpohDistribution of Reporting Centre, 2004-2008 0 Table 7.2.1

Hospital Kemaman 0 Reporting centre Nurzahirah, Kuala Terengganu Hospital Sultanah 0 Hospital Melaka 1 Orthopaedics Department Hospital Pulau Pinang 5 Department of Orthopaedics, HUSM Queen of Elizabeth Hospital, Kota Kinabalu Institute Orthopaedic & Traumatology, Hospital Kuala Lumpur 0 Hospital Raja Perempuan Zainab II,UMMC Kota Bharu 5 Department of Orthopaedics Surgery, Hospital Seberang Jaya, Pulau Pinang 0 Department of Orthopaedics, Hospital Pulau Pinang Hospital Selayang 0 Department of Orthopaedics, Hospital Ipoh Hospital Seremban Department of Orthopaedics, Hospital Raja Perempuan Zainab II 2 Hospital Sultanah Aminah, Hospital Johor Bahru 9 Department of Orthopaedics, Umum Sarawak Hospital Sultan Ismail, Johor Bahru Tengku Ampuan Afzan 0 Department of Orthopaedics, Hospital Hospital Tengku Ampuan Afzan, Kuantan 0 Department of Orthopaedics, Hospital Sultanah Aminah Hospital TengkuTrauma Ampuan&Rahimah, Klang 0 Wan Orthopaedic, Sports Injury Centre (WOTSIC), HospitalSpecialist Muar 0 Seremban Hospital Total 26 Department of Orthopaedics, Island Hospital, Pulau Pinang Department of Orthopaedics, Normah Medical Specialist Centre, University Hospitals Kuching HUSM of Orthopaedics, Hospital Fatimah, Ipoh 39 Department HUKM of Orthopaedics, Kota Bharu Medical Centre 3 Department UMMC of Orthopaedics, Pantai Medical Centre, Kuala Lumpur 9 Department Total 51 Department of Orthopaedics, Gleneagles Medical Centre, Pulau Pinang Department of Orthopaedics, Penang Adventis Hospital, Pulau Pinang Private other sectors Spine Unit,and HUSM Amin Dental Surgery, Johor Bahru 0 Total Antal Rastu Sdn Bhd 0 Borneo Indah Sdn. Bhd. 0 Ophthalmology Department Chong Dental Surgery, Seri Kembangan Selangor Department of Ophthalmology, Hospital Tengku Ampuan Rahimah, 0 Klang Hospital Fatimah, Ipoh 1 Department of Ophthalmology, Hospital Tengku Ampuan Afzan, 0 Pantai Medical Centre, Air Keroh Kuantan Mahkota Medical Centre, Melaka 0 Department of Ophthalmology, Hospital Teluk Intan Hospital Tawakal, KL 0 Department of Ophthalmology, Hospital Kuala Lumpur Hospital Tung Shin, Kuala Lumpur 0 Department Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar Jasa DentalofSurgery, Kuala Lumpur 5 Department Ophthalmology, Johnson &ofJohnson Medical Hospital Sungai Buloh 0 Department Ophthalmology, Kemajuanof Abadi Sdn. Bhd. Hospital Umum Sarawak 0 Department of Ophthalmology, Sri Kota Medical Centre, Klang Klinik Pergigian Chong, Tangkak, Johor 0 Department ofMedical Ophthalmology, HUSM Kota Bahru Centre, Kota Bharu 0 Pusat Centre For Sight LamPakar Wah Mata Ee Hospital, Pulau Pinang 0 Total Normah Medical Center, Kuching 0 Pantai Medical Center, Bangsar 0 Others Island Hospital, Pulau Pinang 0 Maxillofacial Surgery, HUSM Sentosa Medical Centre, Kuala Lumpur 0 Timberland MedicalCentre, Centre,Klang Kuching Sri Kota Medical 2 SriStryker Kota Medical Centre, Klang 2 Total Sunway Medical Centre, Selangor 0 Teo Orthopaedic, Kuala Lumpur 0 Grand Total Zimmer 9 Kuching Specialist Hospital, Sarawak 0 Total 19 Grand Total

142 140

13 4 0 2004 0 0 11 02 21 20 0 29 19 1 0 10 5 00 59 0

10 9 10 200 52 0 7 12 0 01 0 13 31 11 0 0 12 0 00 74 1

6 3 200 0 6 0 3 2 7 0 2 0 0 0 3 0 0 0 0 1 1 0 2 0 0 0 2 0 0 29

23 0 20 30 28 0 0 0 0 14 0 0 0 1 12 0 1 2 00 20 0 00 50 00 00 00 02 0 0 11 00 40 01 10 17 3 0 39

30 3 03 0 33 0 0 0 0 17 2 0 0 1 0 5 1 1 0 0 0 0 0 10 02 03 30 0 0 10 10 06 21 0 22 0 0 20

0 0 2 0 0 0 1 8 5 0 0 1 0 2 0 0 0 1 3 23 0 1 0 0 2 0 2 0 1 1 0 0 0 26 3 1 0 0 0 0 0 1 12 1 0 0 35 21 0 53

126

127

3 5 0 8

3 0 200 0200 08 7 0 00 1 00 0 80 0 00 1 00 0 00 0 00 0 1 730 00 0 0 0 20 0 860 0

1 0 1 0 0 0 5

200 00 00 201 1 0 02 0 4 0 0 11 0 0 0 90 015 00 160 01 00 02 01 319 0 1 00 00 200 00 0 1821 1 83

0 0 0 20 0 9 0 0 2 0 31 0 0 0 0 36

189

35 16 10 Tot al2 4 20 11 214 116 15 13 125 240 175 13 5 22 274 1 1

115 4 213 112 140 1 1 1 465 2 4 1 2 26 5 2 3 112 582 15 918 17 11 52 13 816 1 1 21 12 144 41 10 131 51 1 214 628

BONE BONE AND AND TISSUE TISSUE TRANSPLANTATION TRANSPLANTATION

Fifth Fifth Report of the FifthReport Reportof ofthe the National Transplant Registry 2008 National National Transplant Transplant Registry Registry 2008 2008

7.3 Details 7.1 Recipients STOCK OF TISSUE ALLOGRAFTS AND HOSPITALS WHERE TISSUES ARE UTILISED FROM 2004 TO 2008 The bone and tissue allografts recipients’ gender (Table 7.3.1), ethnicity (Table 7.3.1), age (Table 7.3.3) and diagnosis (Table are presented in this One patient In 2008 and in the previous years, the 7.3.4) main tissue allografts that section. were distributed were can undergo more than 1 transplant. amniotic membranes and deep-frozen femoral heads (Table 7.1.1). USM Tissue Bank provided tissue allografts to the Ministry of Health hospitals, private hospitals and other Table Distribution Number of Transplant by Gender, 2004-2008 sectors7.3.1 (Table 7.1.2 and of 7.1.3). 2004 2005 2006 2007 2008 Total No. Allografts % No. % byNo. % No. No. % Table 7.1.1No. Types % of Tissue Supplied USM Tissue Bank, % 2004-2008 Male 9 53 10 45 27 77 21 58 9 43 76 58 No. of pieces Types of Tissue Female 8 Allograft 47 12 55 8 23 15 42 12 57 55 42 2004 2005 2006 2007 2008 Total Total 17 100 22 100 35 100 36 100 21 100 131 100 Deep Frozen Bone Knee Slices 1 0 0 0 0 1 Table by Ethnic Group, Femur 7.3.2 Distribution of Number 9of Transplant 7 5 2 2004-2008 7 30 2004 2005 200854 Total Femoral Head 50 88 2006 75 2007 65 332 Race No. % No. % No. % No. % No. % No. Humerus 1 3 0 2 2 8% Malay 11 65 14 64 26 74 18 50 11 52 80 Tibia 6 1 4 4 8 2361 Chinese 3 18 5 1 23 20 1 12 330 6 29 33 7 25 Radius 27 3 Indian 1 6 1 5 1 3 4 11 1 5 8 3 6 Ulna 0 3 0 0 0 Bumiputra Sabah 0 0 0 0 0 0 0 0 1 5 1 15 1 Patella/ Bone-Patella-Bone 1 1 4 2 7 Bumiputra Sarawak 6 0 3 0 0 0 1 30 0 2 3 2 Others (Type not stated) 1 00 00 Others 1 6 2 9 1 3 1 3 2 10 7 5 Deep Frozen Tendon Total 17 100 22 100 35 100 36 100 21 100 131 100 Achilles Tendon 0 0 0 2 1 3 Quadriceps Tendon 0 0 0 0 5 5 Table 7.3.3 Distribution of Number of Transplant by Age Group, 2004-2008 Others (Type not stated) 0 0 1 3 3 7 2004 2005 2006 2007 2008 Total Freeze Dried Bone Age group % No. %17 No. 19 % No. % 2 No. %27 No. 102% Cancellous chip No. 37 0-9 0 0 1 5 4 11 5 14 4 190 14 Cortical 2 0 0 0 211 10-11 6 6 275 2 2 6 10 3 0 5 240 15 Cortico-cancellous1 711 20-39 9 53 6 270 16 0 46 80 22 8 5 240 44 Others (Type not stated) 834 40-59 5 29 3 14 8 23 11 31 4 19 31 24 Skin 60 2 12 5 23 5 14 10 28 3 14 25 Deep Frozen Skin 0 0 0 0 36 3619 Missing 0 0 1 5 0 0 1 3 0 0 2 2 Amniotic membrane Total 17 100 22 100 35 100 36 100 21 100 131 100 Air-dried & Glycerol Preserved 1128 64 379 175 2081 3827 Mean 37 36 1224 37 37 Total 190 50642 265 30 2234 4419 SD 16 23 20 23 23 22 Median 35 27 36 49 27 35 Min 15 7 0 0 1 0 Max 75 80 77 80 69 80 Gender

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Table of Number Transplant Diagnosis Warranting Tissue Table7.3.4 7.1.2Distribution Hospitals/Other SectorsofUsing Bone,by Tendon and Skin Allografts Provided Graft, 2004-2008 Tissue Bank, 2004-2008 by USM 2004 2005 No. % No. % MOH Congenital deformity 1 6 0 0 Hospital Sultanah Bahiyah, Alor Setar Infection 0 0 0 0 Hospital Umum Sarawak, Kuching Trauma 5 28 1 5 Hospital Ipoh Hospital Kemaman Degenerative disease 1 6 2 9 Hospital- benign Sultanah Nurzahirah, Kuala Terengganu Tumour 5 28 4 18 Hospital Melaka Tumour - malignant 0 0 6 27 Hospital Pulau Pinang Burn 0 1 5 Queen Elizabeth Hospital, Kota0Kinabalu Hospital Raja Perempuan Zainab Scald 0 II, Kota 0 Bharu 0 0 Hospital Seberang Jaya, Pulau 0 Pinang 0 Sports injury 1 5 Hospital Selayang Failed primary surgery 1 6 2 9 Hospital Seremban Ophtalmological disease 0 0 0 0 Hospital Sultanah Aminah, Johor Bahru Others 5 28 3 14 Hospital Sultan Ismail, Johor Bahru Hospital Tengku Ampuan Afzan, Missing 0 Kuantan 0 2 9 Hospital Tengku Ampuan Rahimah, Klang Total 18 100 22 100 Recipients Diagnosis

Hospital Muar

2006 No. 2004 % 1 3 1 3 8 3 6 016 00 0 03 1 1 1 3 5 2 05 53 1 00 0 0 1 3 2 16 942 6 016 00 0 38 0100 0

2007 No. of pieces 2008 Total 2006 No.2007% 2008 % No. Total % 1 3 1 5 4 3 10 6 2 0 19 3 8 2 10 8 635 13 10 6 3 14 39 1 3 5 10 014 16 0 10 0 0 1 3 1 5 5 410 011 10 32 0 0 0 82 0 0 3 0 4 01 07 0 7 0 520 07 00 0 12 0 2 0 214 03 81 02 01 0 0 0 116 02 12 30 0 3 0 15 0 3 0 0 2 5 0 0 6 43 2 1 0 0 5 7 1911 4 1 19 20 19 027 40 20 54 0 11 2 52 73 45 33 0 75 03 01 02 1 0 5 23 5 0 0 0 5 37 100 21 100 136 100

2005 No.

0 29

2 86

2 274

* Total 1 transplantation performed in 2004 and 2007 had 26 2 diagnosis. 59 74 * 3 transplantations performed in 2006 had 2 diagnosis. University Hospitals HUSM HUKM UMMC Total

39 3 9 51

23 2 3 28

30 3 0 33

3 5 0 8

20 0 0 20

115 13 12 140

Private and other sectors Amin Dental Surgery, Johor Bahru Antal Rastu Sdn Bhd Borneo Indah Sdn. Bhd. Chong Dental Surgery, Seri Kembangan Selangor Hospital Fatimah, Ipoh Pantai Medical Centre, Air Keroh Mahkota Medical Centre, Melaka Hospital Tawakal, KL Hospital Tung Shin, Kuala Lumpur Jasa Dental Surgery, Kuala Lumpur Johnson & Johnson Medical Kemajuan Abadi Sdn. Bhd. Klinik Pergigian Chong, Tangkak, Johor Kota Bahru Medical Centre, Kota Bharu Lam Wah Ee Hospital, Pulau Pinang Normah Medical Center, Kuching Pantai Medical Center, Bangsar Island Hospital, Pulau Pinang Sentosa Medical Centre, Kuala Lumpur Sri Kota Medical Centre, Klang Stryker Sunway Medical Centre, Selangor Teo Orthopaedic, Kuala Lumpur Zimmer Kuching Specialist Hospital, Sarawak Total

0 0 0 0 1 0 0 0 0 5 0 0 0 0 0 0 0 0 0 2 2 0 0 9 0 19

0 0 0 0 12 0 2 0 2 0 0 5 0 0 0 0 0 0 1 0 4 0 10 3 0 39

0 2 0 0 0 5 1 0 0 0 0 0 0 2 3 0 0 0 0 0 6 1 0 0 0 20

5 0 0 1 2 0 0 3 0 0 2 2 1 0 0 3 1 0 0 0 12 0 0 21 0 53

0 0 4 0 11 0 0 9 0 0 16 0 0 0 0 3 0 1 0 0 20 0 0 18 1 83

5 2 4 1 26 5 3 12 2 5 18 7 1 2 3 6 1 1 1 2 44 1 10 51 1 214

Grand Total

126

127

189

628

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Fifth Fifth Report of the FifthReport Reportof ofthe the National Transplant Registry 2008 National National Transplant Transplant Registry Registry 2008 2008

7.4 Data ALLOGRAFTS AND HOSPITALS WHERE TISSUES 7.1 Pre-Transplant STOCK OF TISSUE ARE UTILISED FROM 2004 TO 2008 This section presents data on the tissue provider (Table 7.4.1), origin of tissue graft (Table graft type (Table 7.4.3), typeallografts of sterilisation of the graft (Table In 20087.4.2), and intissue the previous years, the main tissue that were distributed were 7.4.4), mode of transport storage of tissue graft to recipient hospital (Table 7.4.5) and amniotic membranes and deep-frozen femoral heads (Table 7.1.1). USM Tissue Bank temperature of storage tissue graft during of transportation (Tableprivate 7.4.6).hospitals and other provided tissue allografts to the Ministry Health hospitals, sectors (Table 7.1.2 and 7.1.3). Table 7.4.1 Distribution of Number of Transplantation according to Tissue Provider, 2004-2008 Table 7.1.1 Types of Tissue Allografts Supplied by USM Tissue Bank, 2004-2008 2004 2005 2006 2007 2008 Total No. of pieces Name of of Tissue Tissue Allograft Bank Types No. % 2004 No. %2005 No. % % No. 2008 % No.Total % 2006 No. 2007 USM Tissue Bank 13 76 18 82 31 89 34 94 21 100 117 89 Deep Frozen Bone Bone Bank, UMMC 1 6 0 0 0 0 0 0 0 0 1 Knee Slices 1 0 0 0 0 1 1 Bone Bank, Hospital Femur 9 7 5 2 7 30 Kuala Lumpur 3 18 0 0 0 0 0 0 0 0 3 2 Femoral Head 50 88 75 65 54 332 Eucara Pharmaceutical Humerus 20 (P) Ltd., India 0 0 01 0 3 2 60 0 02 0 2 8 2 Tibia 6 1 4 4 8 Osteo Tech Inc., USA 0 0 1 5 0 0 0 0 0 0 1 23 1 Radius 30 Missing 0 0 31 14 2 2 61 2 60 0 7 7 5 Ulna 0 3 0 0 0 Total 17 100 22 100 35 100 36 100 21 100 131 3100 Patella/ Bone-Patella-Bone 1 1 4 2 7 15 Others (Type not stated) 0 0 3 Table 7.4.2 Distribution of Number 3of Transplantation by Origin0 of Tissue0 Graft, 2004Deep Frozen Tendon 2008 Achilles Tendon 0 0 0 2 1 3 2004 2005 2006 2007 2008 Total Origin of Tissue Graft Quadriceps Tendon 0 0 0 0 5 5 No. % No. % No. % No. % No. % No. % Others (Type not stated) 0 0 1 3 3 7 Local 17 100 15 68 31 89 34 94 20 95 117 89 Freeze Dried Bone Imported 0 0 3 14 2 6 0 0 0 0 5 4 Cancellous chip 17 19 37 2 27 102 Missing 0 0 4 18 2 6 2 6 1 5 9 7 Cortical 2 0 0 0 0 2 Total 17 100 22 100 35 100 36 100 21 100 131 100 Cortico-cancellous 5 2 0 0 0 7 Others (Type not stated) 0 0 0 8 0 8 Table 7.4.3 Distribution of Number of Transplantation by Tissue Graft Types, 2004Skin 2008 Deep Frozen Skin 0 0 0 0 36 36 2004 2005 2006 2007 2008 Total Amniotic membrane Tissue graft types No. % 1128 No. % 64 No. % % No. 2081 % No.3827 % Air-dried & Glycerol Preserved 379 No. 175 Deep 9 53 1224 14 64190 5 14 14 2 2234 10 35 4419 27 Totalfrozen tissues 506 5 265 Freeze dried (Lyophilised) 6 35 4 18 29 83 31 86 16 76 86 66 Not Available 2 12 2 9 0 0 0 0 0 0 4 3 Missing 0 0 2 9 1 3 0 0 3 14 6 5 Total 17 100 22 100 35 100 36 100 21 100 131 100

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Table Distribution of Sectors Tissue Graft 2004-2008 Table7.4.3(a) 7.1.2 Hospitals/Other UsingTypes Bone,(breakdowns), Tendon and Skin Allografts Provided 20042004-2008 2005 2006 2007 2008 Total Tissue graftTissue types Bank, by USM (breakdowns) No. % No. % Recipients 3 11 3 7 Femur MOH 2 7 12 26 Femoral head Hospital Sultanah Bahiyah, Alor Setar 0 Kuching 0 1 2 Humerus Hospital Umum Sarawak, 1 4 1 2 Tibia Hospital Ipoh Hospital Kemaman 2 7 5 11 Radius Hospital Sultanah Nurzahirah, Kuala Terengganu 1 4 1 2 Patella Hospital Melaka Other tendon 0 0 0 Hospital Pulau Pinang 0 fascia cartilage Queen Elizabeth Hospital, Kota Kinabalu Amniotic Hospital Raja Perempuan 2 Zainab7 II, Kota 3 Bharu7 membranes Hospital Seberang Jaya, Pulau Pinang 15 56 19 41 Cancellous Hospital Selayang Hospital Seremban 0 0 0 0 Cortical Hospital Sultanah Aminah, Johor Bahru Cortical 1 4 1 2 Hospital Sultan Ismail, Johor Bahru cancellous Hospital Tengku Ampuan Afzan, Kuantan 0 0 0 0 Bone granule Hospital Tengku Ampuan Rahimah, Klang 0 0 0 0 Bone powder Hospital Muar Total 27 100 46 100 Total

No. 0 2 3 1 0 2

% 02004 4 1 73 20 00 40

56 5

2 6

40 13 2

20 0 70 10026

1 3 45

No. % 0 2005 0 7 18 10 0 13 0 0 4 0 0 0 0 0 0 0

% No.No. of pieces 20061 2007 5

University Hospitals Table 7.4.4 Distribution of Graft Sterilization Types, 2004-2008 HUSM 39 23

2004 2005 Graft sterilization HUKM types No. % No. % UMMC Total irradiation Gamma 16 94 15 68 Glycerol 0 0 0 0 Private and other sectors Sterile freeze dried Amin Dental Surgery, Johor0 Bahru0 1 5 human bone Antal Rastu Sdn Bhd Missing 6 6 27 Borneo Indah Sdn. Bhd. 1 Total 17Kembangan 100 Selangor 22 100 Chong Dental Surgery, Seri

2006 3 No. % 9 51 30 86 2 6 0

0 3 90 35 100 0 Hospital Fatimah, Ipoh 1 Pantai Medical Centre, Air Keroh 0 Table 7.4.5 Distribution of Mode of Transport Storage Mahkota Medical Centre, Melaka 0 Transportation, 2004-2008 Hospital Tawakal, KL 0 Mode of transport Hospital Tung Shin, Kuala Lumpur 2004 2005 2006 0 Jasa Dental Surgery, Kuala Lumpur 5 storage to recipient No. % No. % No. % Johnson & Johnson Medical 0 hospital 6 1 5 2 60 ByKemajuan flight Abadi Sdn. Bhd.1 Klinik Pergigian Chong, Tangkak, Johor 0 2 12 3 14 24 69 By courier Kota Bahru Medical Centre, Kota Bharu 0 4 Pinang 24 8 36 1 30 ByLam hand Wah Ee Hospital, Pulau 5 29 4 18 0 00 Dry ice box Normah Medical Center, Kuching Pantai Medical Center, Bangsar 0 0 0 0 0 2 6 Sterile package Island Hospital, Pulau Pinang 0 5 29 6 27 6 17 Missing Sentosa Medical Centre, Kuala Lumpur 0 17 100 22 100 35 100 Total Sri Kota Medical Centre, Klang 2 Stryker 2 Sunway Medical Centre, Selangor 0 Teo Orthopaedic, Kuala Lumpur 0 Zimmer 9 Kuching Specialist Hospital, Sarawak 0 Total 19 Grand Total

146 140

6 10 0 9 0 10 0 2 0 0 0 1 1 3 7 0 0 12 31 2 79 1 19 2 0 0 0 0 3 0 0 2 0 1 0 19 11 0 0 0 0 0 0 1 0 2 0 5 0 0 0 0 0 0 39 59 100 74 22 30

2 60 30 00 00 3 70 2 086 3 00 00 1 20 00 0 00 100 29 3

2007 2008 2 3 5 No.3 % 0 No. 0 % 2728 75 33 19 8 90 0 0 0 0 00

0 0 0 50 0 2 0 9 0 25 0 2 0 10 36 0 100 0 21 1100 12 0 2 0 5 0 to Recipient Hospital 2 1 0 0 0 3 2 0 0 2007 2008 0 0 0 No.0 % 0 No. 2 % 25 6 0 1 25 0 0 1 23 64 17 81 0 2 0 00 0 3 0 00 00 0 0 0 30 00 0 0 0 10 11 0 31 0 3 0 14 1 0 0 36 0 100 0 21 0100 4 6 12 0 1 0 10 0 0 3 0 21 0 0 0 39 20 53 126

127

No.

2008 7

Total 4

25 0 34 03 07 04

14 19 235 216 410 22

0 01 0 8 80 0 36 0 06 0 2 73 01 0 23 179 86

120 14

4516 5

203 35

175

13 5 22 100 274

20 115 0 Total 13 No. % 0 12 20 140 107 82

01 15 0 2 21 164 4 131 100 0 1 11 26 0 5 during 0 3 9 12 0 Total 2 0 5 No. % 16 18 07 57 0 69 531 0 2 13 103 0 76 39 02 21 1 31 241 0 1 131 100 0 2 20 44 0 1 0 10 18 51 1 1 83 214 189

628

BONE BONE AND AND TISSUE TISSUE TRANSPLANTATION TRANSPLANTATION

Fifth Fifth Report of the FifthReport Reportof ofthe the National Transplant Registry 2008 National National Transplant Transplant Registry Registry 2008 2008

Table 7.4.6 Distribution of ALLOGRAFTS Temperature of Storage during Transportation, 7.1 STOCK OF TISSUE AND HOSPITALS WHERE2004-2008 TISSUES Temperature of storage 2004 TO 2008 2005 2006 2007 2008 Total ARE UTILISED FROM 2004

during transportation No. % No. % No. % No. % No. % No. % (ยบC) In 2008 and in the previous years, -80 2 12 the 0 main 0 tissue 0 allografts 0 0 that 0 were 0 distributed 0 2 were 2 amniotic membranes and deep-frozen femoral heads (Table 7.1.1). USM Tissue Bank -40 0 0 1 5 0 0 0 0 0 0 1 1 provided tissue allografts to Ministry hospitals -20 4 the24 4 of 18Health 0 hospitals, 0 1 private 3 0 0 and 9 other 7 sectors (Table 7.1.2 and 7.1.3). -10 0 0 6 27 2 6 1 3 1 5 10 8 0 2 12 0 0 0 0 0 0 0 0 2 2 Table 7.1.1 Types of Tissue Tissue 37 0 Allografts 0 0 Supplied 0 2by USM 6 0 0Bank, 0 2004-2008 0 2 2 of pieces Room temperature 3 18 4 18 25 71 No.22 61 17 81 71 54 Types of Tissue Allograft 2005 6 2006 Missing 6 35 20047 32 17 12 2007 33 3 2008 14 34Total 26 Deep Frozen Bone Total 17 100 22 100 35 100 36 100 21 100 131 100 Knee Slices 1 0 0 0 0 1 Femur 9 7 5 2 7 30 Femoral Head 50 88 75 65 54 332 Humerus 1 3 0 2 2 8 Tibia 6 1 4 4 8 23 Radius 1 2 1 0 3 7 Ulna 0 3 0 0 0 3 Patella/ Bone-Patella-Bone 1 1 4 2 7 15 Others (Type not stated) 3 0 0 0 0 3 Deep Frozen Tendon Achilles Tendon 0 0 0 2 1 3 Quadriceps Tendon 0 0 0 0 5 5 Others (Type not stated) 0 0 1 3 3 7 Freeze Dried Bone Cancellous chip 17 19 37 2 27 102 Cortical 2 0 0 0 0 2 Cortico-cancellous 5 2 0 0 0 7 Others (Type not stated) 0 0 0 8 0 8 Skin Deep Frozen Skin 0 0 0 0 36 36 Amniotic membrane Air-dried & Glycerol Preserved 1128 64 379 175 2081 3827 Total 1224 190 506 265 2234 4419

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7.5 Transplant Surgery DataSectors Using Bone, Tendon and Skin Allografts Provided Table 7.1.2 Hospitals/Other by USM Tissue Bank, 2004-2008 pieces The data on mode of storage of tissues in recipient hospitals No. areofpresented in Table Recipients 2004 2005 2006 2007 2008 Total 7.5.1. This section also presents the data on the use of composite graft (Tables 7.5.2 and MOH 7.5.3), of preAlor operative infection at implant site of Hospitalpresence Sultanah Bahiyah, Setar 1 10 (Table 6 7.5.4), 2 presence 0 19 infection of pre implanted Hospital Umum Sarawak, Kuchinggrafts (Tables 7.5.5 and3 7.5.6)13and the 10 usage 6 of antibiotics 3 35 Hospital 7.5.7, Ipoh 7.5.8, 7.5.9, and 7.5.10) 0 4 9 3 0 16 (Tables Hospital Kemaman Hospital Sultanah Nurzahirah, Kuala Terengganu Table 7.5.1 Distribution of Mode of Storage Hospital Melaka 2004 2005 Mode of storage in Hospital Pulau Pinang Queen Elizabeth Kinabalu recipient hospitalHospital, Kota No. % No. % Hospital Raja Perempuan Zainab Refrigerator 0 II, 0Kota Bharu 1 5 Hospital Seberang Jaya, Pulau Pinang Deep Freezer -20 ºC 0 0 3 14 Hospital Selayang Deep Freezer -40 ºC 1 6 2 9 Hospital Seremban Hospital Sultanah Aminah, Johor Deep Freezer -80 ºC 3 Bahru 18 4 18 Hospital Sultan Ismail, Johor0Bahru 0 Liquid Nitrogen 0 0 Hospital Tengku Ampuan Afzan, Kuantan Glycerol 0 0 1 5 Hospital Tengku Ampuan Rahimah, Klang Room Temperature 0 0 1 5 Hospital Muar Others 12 71 5 23 Total

Not Available University Hospitals Missing HUSM Total HUKM

1 0 17

6 0 100

0 5 22

0 23 100

0 0 10 0 0 0 2 0 in Recipient Hospital, 1 0 0 2004-2008 3 2006 5 2008 12007 7 7 0 No. % No.0 % 12 No. 2 % 5 25 71 282 78 1 12 0 57 0 2 0 3 2 30 8 3 0 0 0 06 0 02 0 1 1 0 5 20 93 1 119 3 11 0 1 0 00 0 00 0 0 0 2 0 0 1 2 0 3 9 4 11 6 29 0 5 0 0 1 00 0 0 2 0 10 03 2 6 059 0 74 0 29 0 26

0 1 35

UMMC

0 3 39 100 3 9

0 0 0 0 0 0 23 30 362 100 3 21 3

0 0 3 100 5 0

0 10 0 2 0 4 0 Total 20 0 14 No. % 866 16 50 0 5 63 08 35 04 09 740 730 075 0 3 14 11 0 5 32 24 19 15 86 274

1 6 20 131 0 0

1 5 115 100 13

Total 7.5.2 Distribution of Additional Tissue Usage 51(Composite 28 33 8 20 Table Graft), 2004-2008

2004 2005 No. % No. % Amin Dental Surgery, Johor Bahru Yes 9 53 7 32 Antal Rastu Sdn Bhd Borneo Indah Sdn. Bhd. • Autografts 7 41 3 14 Chong Dental Surgery, Seri Kembangan • Allografts 1 6 Selangor 2 9 Hospital Fatimah, Ipoh • Others 1 6 1 5 Pantai Medical Centre, Air Keroh • Missing 0 0 1 5 Mahkota Medical Centre, Melaka NoHospital Tawakal, KL 6 35 12 55 Hospital Tung Shin, Kuala Lumpur Not Available 2 12 1 5 Jasa Dental Surgery, Kuala Lumpur Missing 0 0 2 9 Johnson & Johnson Medical Total 17 100 22 100 Kemajuan Abadi Sdn. Bhd. Additional Tissue Used Private and other sectors

Klinik Pergigian Chong, Tangkak, Johor

2006 No. 0% 1 03 00 0 03 1 1 0 0 0 0 0 0 32 091 00 0 56 2 0 35 100 0 0

2007 2008 No. % 0 No. 5 % 0 20 6 2 1 0 5 00 0 0 1 0 5 20 6 0 0 1 0 12 0 0 0 0 2 0 0 5 0 02 0 1 0 0 0 330 92 0 19 3 90 2 0 0 0 0 0 0 0 1 3 0 1 0 5 0 0 2 365 100 0 21 2100

12 140

Total No. %5 0 152 020 411 84 06 51 11 2 226 0 5 13 01 102 78 9 12 03 22 06 55 16 18 131 100 0 7

0 19

1 2 3 0 0 3 3 6 2008 0 2007 0 1 0 Total 1 No. %0 No. 0 % No. %1 0 1 19 250 3 0 14 016 121 0 0 27 750 18 0 86 112 852 4 6 12 20 44 0 0 0 0 2 2 0 1 0 0 1 00 0 0 0 110 100 01 36 1000 21 21 100 18 131 100 3 51 0 0 0 1 1 39 20 53 83 214

126

127

Kota Bahru Centre, Kota Bharu 0 Infection 0 0 Site, 02004Table 7.5.3Medical Distribution of Presence of Pre Operative at2Implant Lam Wah Ee Hospital, Pulau Pinang 0 0 3 0 0 2008 Normah Medical Center, Kuching

Presence of preCenter, operative Pantai Medical Bangsar 2004 infection at implant site % Island Hospital, Pulau Pinang No. Sentosa Medical Centre, Kuala Lumpur Yes 0 0 NoSri Kota Medical Centre, Klang 15 88 Stryker Not Available 2 12 Sunway Medical Centre, Selangor Missing 0 Teo Orthopaedic, Kuala Lumpur 0 Total 17 100 Zimmer Kuching Specialist Hospital, Sarawak Total

2005 No. % 0 0 21 95 0 0 1 5 22 100

2006 0 No. 0 % 4 0 11 31 2 89 2 0 0 0 0 0 0 35 9 100

Grand Total

148 140

189

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Fifth Fifth Report of the FifthReport Reportof ofthe the National Transplant Registry 2008 National National Transplant Transplant Registry Registry 2008 2008

Table 7.5.4 Distribution of ALLOGRAFTS Pre Implant GraftAND Cultural Swab, 2004-2008 7.1 STOCK OF TISSUE HOSPITALS WHERE TISSUES 20042004 TO 2005 2006 2007 2008 Total Pre implant graft ARE UTILISED FROM 2008

cultural swab No. % No. % No. % No. % No. % No. % Yes 0 0 1 5 0 0 1 3 0 0 2 2 In 2008 and in the previous years, the main tissue allografts that were distributed were • Cytomegalovirus 0 0 1 5 0 0 0 0 0 0 1 1 amniotic membranes and deep-frozen femoral heads (Table 7.1.1). USM Tissue Bank • Proteustissue allografts 0 to0the Ministry 0 0 of Health 0 0hospitals, 1 3 0 hospitals 0 1 other 1 provided private and No 15 88 16 73 17 49 22 61 18 86 88 67 sectors (Table 7.1.2 and 7.1.3). Not Available 2 12 0 0 6 17 5 14 0 0 13 10 Missing 0 0Allografts 5 23 12 by 34USM8 Tissue 22 Bank, 3 2004-2008 14 28 21 Table 7.1.1 Types of Tissue Supplied Total 17 100 22 100 35 100 36 100 21 100 131 100 No. of pieces Types of Tissue Allograft 2004 2005 2006 2007 2008 Total Table 7.5.5 Distribution of Grafts Soaked in Antibiotics Prior to Transplantation, 2004Deep Frozen Bone 2008 Knee Slices 1 0 0 0 0 1 Grafts soaked in 2004 2005 2006 2007 2008 Total Femur 9 7 5 2 7 30 antibiotics prior to No. % No.50 % 88 No. % 75No. %65 No. 54 % No. 332% Femoral Head transplantation Humerus 36 25 Yes 7 41 16 1 73 17 0 6 172 1 36 8 27 Tibia 6 1 4 4 8 • Ceftriazone 4 24 9 41 3 9 0 0 0 0 16 2312 Radius 23 35 • Gentamicin 3 18 4 1 18 9 1 4 110 1 15 7 11 Ulna 0 3 0 0 0 3 • Povidone iodine, 0 0 1 5 0 0 0 0 0 0 1 1 Patella/ Bone-Patella-Bone 1 1 4 2 7 15 Ceftriazone • Ceftriazone Others (Type notand stated) 0 00 00 0 0 3 0 0 0 1 30 0 1 3 1 Gentamicin Deep Frozen Tendon • Vancomycin, Achilles Tendon 00 10 0 0 1 0 5 0 0 0 02 0 1 3 1 Postome iodine Quadriceps Tendon 0 0 0 0 5 5 • Missing 0 0 1 5 0 0 1 3 0 0 2 2 Others (Type not stated) 0 0 1 3 3 7 No 8 47 5 23 28 80 28 78 20 95 89 68 Freeze Dried Bone Not Available 2 12 0 0 1 3 0 0 0 0 3 2 Cancellous chip 17 19 37 2 27 102 Missing 0 0 1 5 0 0 2 6 0 0 3 2 Cortical 2 0 0 0 0 2 Total 17 100 22 100 35 100 36 100 21 100 131 100 Cortico-cancellous 5 2 0 0 0 7 Others (Type not stated) 0 0 0 8 0 8 Skin Deep Frozen Skin 0 0 0 0 36 36 Amniotic membrane Air-dried & Glycerol Preserved 1128 64 379 175 2081 3827 Total 1224 190 506 265 2234 4419

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BONE BONEAND ANDTISSUE TISSUETRANSPLANTATION TRANSPLANTATION

Table of Number Transplant Systemic Given Prior Table7.5.6 7.1.2Distribution Hospitals/Other SectorsofUsing Bone,by Tendon andAntibiotics Skin Allografts Provided toby Transplantation, 2004-2008 USM Tissue Bank, 2004-2008 2004 2005 Systemic antibiotics given Recipients prioir to transplantation No. % No. % MOH Yes 12 71 17 77 Hospital Sultanah Bahiyah, Alor Setar • Cefeperazone 2 12 2 9 Hospital Umum Sarawak, Kuching • Ceftriazone/ Imipenam 2 12 2 9 Hospital Ipoh Hospital Kemaman • Cefuroxine 7 41 7 32 Hospital Sultanah Nurzahirah, Kuala • Ciproflaxacin 0 Terengganu 0 2 9 Hospital Melaka • Chloramphenicol 0 0 0 0 Hospital Pulau Pinang • Gentamicin 0 0 0 0 Queen Elizabeth Hospital, Kota Kinabalu • Metronidazole 1 Kota6Bharu1 5 Hospital Raja Perempuan Zainab II, Hospital Seberang Jaya, Pulau Pinang • Ceftazidime 0 0 0 0 Hospital Selayang • T. Augmentin 0 0 0 0 Hospital Seremban • T.Flurariazole 0 0 Hospital Sultanah Aminah, Johor 0 Bahru 0 • Ampicillin Sulbactam 0 0 2 9 Hospital Sultan /Ismail, Johor Bahru Hospital Tengku Ampuan Afzan, 0 Kuantan • Missing 0 1 5 Hospital Tengku Ampuan Rahimah, Klang No 4 24 3 14 Hospital Muar Not Available 1 6 0 0 Total Missing 0 0 2 9 Total 17 100 22 100 University Hospitals HUSM HUKM UMMC Total

2006 2007 No. of pieces 2008 Total 2006 No.2007% 2008 No.2004% 2005 No. % No. Total % 9 26 10 28 3 14 51 39 1 10 6 2 0 19 0 3 0 0 0 0 0 4 335 13 10 6 3 3 0 9 89 0 3 0 816 43 010 0 0 10 0 0 10 4 11 2 6 1 5 21 16 0 0 2 0 0 0 0 2 6 1 5 5 42 1 0 0 3 0 4 1 3 0 0 0 0 1 1 5 1 7 7 0 20 0 0 0 012 1 2 5 114 00 01 0 5 0 01 0 0 0 216 20 82 20 01 1 0 3 00 0 3 0 15 01 01 0 0 0 33 0 0 0 13 2 2 1 0 0 5 0 9 0 611 0 1 0 240 192 02 0 0 0 00 0 2 0 732 275 00 10 01 0 0 0 02 0 0 0 13 0 5 0 0 0 26 74 26 72 17 81 76 585 0 0 0 0 2 2 0 0 0 0 0 0 1 1 26 59 74 29 86 274 0 0 0 0 1 5 3 2 35 100 36 100 21 100 131 100 39 3 9 51

23 2 3 28

30 3 0 33

3 5 0 8

20 0 0 20

115 13 12 140

0 0 0 0 1 0 0 0 0 5 0 0 0 0 0 0 0 0 0 2 2 0 0 9 0 19

0 0 0 0 12 0 2 0 2 0 0 5 0 0 0 0 0 0 1 0 4 0 10 3 0 39

0 2 0 0 0 5 1 0 0 0 0 0 0 2 3 0 0 0 0 0 6 1 0 0 0 20

5 0 0 1 2 0 0 3 0 0 2 2 1 0 0 3 1 0 0 0 12 0 0 21 0 53

0 0 4 0 11 0 0 9 0 0 16 0 0 0 0 3 0 1 0 0 20 0 0 18 1 83

5 2 4 1 26 5 3 12 2 5 18 7 1 2 3 6 1 1 1 2 44 1 10 51 1 214

Grand Total

126

127

189

628

150 140

CHAPTER 8

CADAVERIC ORGAN AND TISSUE DONATION

Editor: Datin Dr Lela Yasmin Mansor Expert Panel Datin Dr Lela Yasmin Mansor (chairperson) Dr Hooi Lai Seong Dr Omar Sulaiman Dr Muhammed Anis Abdul Wahab Matron Jamaliah Kario Staff Nurse Santi A/P Krishanan

CADAVERIC ORGAN AND TISSUE DONATION CADAVERIC ORGAN AND TISSUE DONATION

Fifth Report of the National Transplant FifthRegistry Reportof2008 of Fifth Report thethe

National Transplant Transplant Registry National Registry2008 2008

List of Tables Table Number of Donations by Year, 1997-2008 ..............................................154 List of8.1: Tables Table8.1: 8.2:Number Numberof ofDonations organs procured, 1997-2008...................................................155 Table by Year, 1997-2008 ..............................................154 Table8.2: 8.3:Number PotentialofDonor and Actual Donations by month, 2008 ...........155 Table organsReferrals procured, 1997-2008...................................................155 Table8.3: 8.4:Potential Distribution of Donors byand Age, 1997-2008…………………………..…157 Table Donor Referrals Actual Donations by month, 2008 ...........155 Table8.4: 8.5:Distribution Distributionof ofDonors Donorsby byAge, Gender, 1997-2008.........................................160 Table 1997-2008…………………………..…157 Table8.5: 8.6:Distribution Distributionof ofDonors Donorsby byGender, Ethnic Group, 1997-2008...............................162 Table 1997-2008.........................................160 Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table 8.6: Distribution of Donors by Ethnic Group, 1997-2008...............................162 Table8.7: 8.8:Distribution Distributionof ofDonors Donorsby byReligion, Nationality, 1997-2008...................................166 Table 1997-2008.......................................164 Table8.8: 8.9:Distribution Distributionof ofDonors Donorsby byNationality, State, 1997-2008.............................................168 Table 1997-2008...................................166 Table8.9: 8.10:Distribution Donor’s Pledged Status, 1997-2008 .......................................................169 Table of Donors by State, 1997-2008.............................................168 Table8.10: 8.11:Donor’s Distribution of Donors Type, 1997-2008 ..........................................171 Table Pledged Status,by 1997-2008 .......................................................169 Table8.11: 8.12:Distribution Distributionof ofDonors Donorsby byType, Cause1997-2008 of Death, 1997-2008………………..172 Table ..........................................171 Table8.12: 8.13:Distribution Distributionof ofDonors Organ Donors byof Blood Group, 1997-2008...................174 Table by Cause Death, 1997-2008………………..172 Table8.13: 8.14a:Distribution DistributionofofOrgan Donors by Institution Origin,1997-2008...................174 1997-2008.................176 Table Donors by BloodofGroup, Table8.14a: 8.14b:Distribution Distributionof ofDonors Donorsby byInstitution Referral Site, 1997-2008 ............................177 Table of Origin, 1997-2008.................176 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table8.14c: 8.15: Distribution 2008Site, ..............................................179 Table Distribution of of Donors Donors by by Inotrope, Procurement 1997-2008 .....................178 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 List of Figures Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 List of Figures Figure8.1: 8.3:Number PotentialofDonor Referrals and Actual Donations by month, 2008..……156 Figure Donations by Year, 1997-2008 .............................................154 Figure8.3: 8.4:Potential Distribution of Donors byand Age, 1997-2008.............................................158 Figure Donor Referrals Actual Donations by month, 2008..……156 Figure8.4: 8.5:Distribution Distributionof ofDonors Donorsby byAge, Gender, 1997-2008 .......................................160 Figure 1997-2008.............................................158 Figure8.5: 8.6:Distribution Distributionof ofDonors Donorsby byGender, Ethnic Group, 1997-2008..............................162 Figure 1997-2008 .......................................160 Figure8.6: 8.7:Distribution Distributionof ofDonors Donorsby byEthnic Religion, 1997-2008 .....................................164 Figure Group, 1997-2008..............................162 Figure8.7: 8.8:Distribution Distributionof ofDonors Donorsby byReligion, Nationality, 1997-2008 .................................166 Figure 1997-2008 .....................................164 Figure8.8: 8.10:Distribution Donor’s Pledged Status, 1997-2008......................................................169 Figure of Donors by Nationality, 1997-2008 .................................166 Figure8.10: 8.11:Donor’s Distribution of Donors Type, 1997-2008 .........................................171 Figure Pledged Status,by 1997-2008......................................................169 Figure8.11: 8.13a:Distribution DistributionofofDonors Organby Donors Blood Group, 1997-2008 ...............174 Figure Type,by 1997-2008 .........................................171 Figure8.13a: 8.13b:Distribution Distributionof ofOrgan OrganDonors Donor by Blood Group (pie chart), 1997- Figure Group,Type 1997-2008 ...............174 2008…………………………….…………………………………....176 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 1997Figure 8.13c: 2008…………………………….…………………………………....176 Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), Figure 8.14a: 2008…………………………….……………………………….…...176 Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure8.14a: 8.14b:Distribution Distributionof ofDonors Donorsby byInstitution Referral Site, 1997-2008...........................177 Figure of Origin, 1997-2008 ...............176 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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CADAVERIC ORGAN AND TISSUE DONATION CADAVERIC ORGAN AND TISSUE DONATION

CADAVERIC ORGAN AND TISSUE DONATION CADAVERIC ORGAN AND TISSUE DONATION There was an increase in the number of potential cadaveric donors referred to the National Transplant Procurement Unit (NTPMU) 73referred the previous There was an increase in the number of potentialnationwide cadaveric from donors to the year to 112Transplant in 2008. The number ofUnit actual donors remained about the 73 same 26 for National Procurement (NTPMU) nationwide from theatprevious the year, which translated a conversion rate of 23% and a donation rate of 0.94 year to 112 in 2008. The to number of actual donors remained about the same at 26per for million population (Table to 8.1). Of these rate 13 (50%) deadrate donors who the year, which translated a conversion of 23%were and abrain donation of 0.94 per donated and (Table tissues 8.1). whichOfwere in were the operating theatre, million organs population theseprocured 13 (50%) brain dead donorswhile who another were tissue donations afterwere cardiac death (Table Table 8.11). In total donated13organs and tissues which procured in the8.2, operating theatre, while 87 organs13 and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 another were tissue donations after cardiac death (Table 8.2, Table 8.11). In total pairs of heart valves andwere 4 sets of long bones. 87 organs and tissues procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 pairs of heart valves and 4 sets of long bones. The number of donations throughout the year did not conform to any particular trend (Table 8.3). There were 4 paediatric (age – 9conform years) and 4 teenage donors The number of donations throughoutdonors the year did1not to any particular trend which constitute of the donors total number 8.4). Another (Tabletogether 8.3). There were 431% paediatric (age 1 of – 9donors years) (Table and 4 teenage donors 23% (6/26) were constitute in their twenties means that 54% of donors were under the which together 31% ofwhich the total number of donors (Table 8.4). Another age of (6/26) thirty. were The in mean was 30.8 years, age that range 2 –of71donors years.were Maleunder donors 23% theirage twenties which means 54% the outnumber female to one 8.5).years, age range 2 – 71 years. Male donors age of thirty. Thethree mean age (Table was 30.8 outnumber female three to one (Table 8.5). Two thirds of donors were Chinese, 23% Indian and 12% others by ethnicity (Table 8.6), Buddhist byChinese, religion 23% (Table 8.7). and Two12% donors were Two62% thirdswere of donors were Indian others by non-Malaysian ethnicity (Table (Table 8.8). were Majority of the by donors came(Table from the Federal Territory of Kuala Lumpur 8.6), 62% Buddhist religion 8.7). Two donors were non-Malaysian (31%) by Johor, Selangor each) (Table 8.9). out (Tablefollowed 8.8). Majority of the donors and camePerak from(12% the Federal Territory of Only Kualatwo Lumpur of(31%) the 26followed actual donors (8%)Selangor had pledged to donate before carried theOnly donor card by Johor, and Perak (12% each)and (Table 8.9). two out (Table of the 8.10). 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 8.10). Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% cardiac death.cause Another 23% accounting of brain dead Cardiac disease was of thethe most common of death, for donors 23% ofand the 15% post-cardiac tissue donors diedAnother from motor (Table brainofdeath and 54%death of the cardiac death. 23% vehicle of brainaccidents dead donors and 8.12). the mostdeath common group 13 organ was group 15% In of 2008, post-cardiac tissueblood donors diedamong from the motor vehicledonors accidents (Table O8.12). rhesus followedblood by Agroup positive (31%), B positive (15%), only 1 In positive 2008, the(46%), most common among the 13 organ donors was group (8%) from positive group A(46%), negative and nobyAB (Table 8.13). When considered O rhesus followed A group positive (31%), B positive (15%), onlyin1 totality since group 1997, A blood groupand O positive the most common (40%)in (8%) from negative no AB remained group (Table 8.13). When group considered followed by B positive and A positive. totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from 3 (12%) hospitals (Table 8.14a). Sixty-five Mostprivate of the hospitals donationsand (58%) took from placeUniversity in Ministry of Health hospitals with 6 (23%) percent of the hospitals donors were in from the ICU, but there were also four8.14a). direct Sixty-five referrals from private and found 3 (12%) University hospitals (Table for tissueofdonation from mortuary with but three from thealso ward onereferrals from percent the donors werethe found in the ICU, there were fourand direct emergency (“brought in dead” BID) for tissue department donation from the mortuary with (Table three 8.14b). from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while in the theatre mortuary (Tableof8.14c). the Organtissues donorswere weremainly sent toprocured the operating for (12/13) procurement organsFor (13/13) organ weremainly on inotropic support procurement with the commonest whiledonors tissuesall were procured in thebefore mortuary (12/13) (Table 8.14c). For the combination being dopamine and noradrenaline (6/13)procurement (Table 8.15).with the commonest organ donors all were on inotropic support before combination being dopamine and noradrenaline (6/13) (Table 8.15).

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Number of donors (n)

Table 8.1: Number of Donations by Year, 1997-2008 Number of procurement by year List of Tables Table 8.1: Number of Donations by Year,N=213 1997-2008 ..............................................154 Year 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Table 8.2: Number of organs procured, 1997-2008...................................................155 Number of 5 7 4 13 24 30 25 16 13 25 25 26 Table donors8.3: Potential Donor Referrals and Actual Donations by month, 2008 ...........155 Table 8.4: Distribution of Donors by Age, 1997-2008…………………………..…157 Rate of Table 8.5: Distribution of Donors by Gender, 1997-2008.........................................160 procurement (per 0.23 0.32 0.18 0.55 1.00 1.22 1.00 0.63 0.50 0.94 0.92 0.94 million Table 8.6: Distribution of Donors by Ethnic Group, 1997-2008...............................162 population) Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table 8.8: Distribution of Donors by Nationality, 1997-2008...................................166 Figure8.9: 8.1:Distribution Number of of Donations by State, Year, 1997-2008.............................................168 1997-2008 Table Donors by Table 8.10: Donor’s Pledged Status, 1997-2008 .......................................................169 Table30 8.11: Distribution of Donors by Type, 1997-2008 ..........................................171 Table 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Table 8.13: Distribution of Organ Donors by Blood Group, 1997-2008...................174 Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 20 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 List of Figures Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure108.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 0 Figure 8.11:1997 Distribution of Donors by Type, 1998 1999 2000 2001 2002 1997-2008 2003 2004 .........................................171 2005 2006 2007 2008 Figure 8.13a: Distribution of Organ DonorsYear by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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CADAVERIC ORGAN AND TISSUE DONATION CADAVERIC ORGAN AND TISSUE DONATION

Table 8.2: Number of organs procured, 1997-2008 CADAVERIC ORGAN AND Number TISSUE Organs of DONATION procurement by year N=213 procured

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 There was an1997 increase in the number of potential cadaveric donors referred to the Cornea 4 10 6 18 32 48 40 20 22 38 32 40 National Transplant Procurement Heart 1 3 2 3 Unit4 (NTPMU) 0 2nationwide 0 1from 173 the 3 previous 0 year to 112 in 2008. The number donors about the Liver 0 0 2 2of actual 1 2 1remained 3 3 6 same 5 at 26 4 for the year, which8translated to6 a conversion of 0.94 Kidney 10 22 38 rate 26 of 23% 16 and 18 a donation 8 26rate 28 26 per Heart valve 0 1 28.1). 8Of these 10 10 (50%) 10 were 10 brain 6 15 donors 8 13who million population (Table 13 dead Bone 0 1 0 3 2 6 4 5 2 5 5 4 donated organs and tissues which were procured in the operating theatre, while Skin 0 0 0 2 2 2 0 1 0 3 0 0 another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total Lung 0 0 0 0 0 0 0 0 1 1 2 0

87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 pairs of heart valves and 4 sets of long bones. Table 8.3: Potential Donor Referrals and Actual Donations by month, 2008

of donors The number of donations throughout theNo. year did not conform to any particular trend (Table 8.3). There were 4 paediatric donors (ageActual 1 – 9Donors years) and 4 teenage donors Month Potential Donor which together constitute 31% of the total number of donors Referrals Brain Death Cardiac Death (Table 8.4). Another Total 23% (6/26) were in their twenties which means thatDonors 54% of donors were under the Organ Donors (BD) Tissue (CD) age donors 10 mean age was 30.8 1 years, age range 0 2 – 71 years. Male 1 Janof thirty. The outnumber female three to one (Table 8.5). 10 1 3 4 Feb Mar

Two thirds of donors were Chinese, 023% Indian and 12% others by ethnicity (Table 9 1 1 Apr 8.6), 62% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian 6 1 0 1 May (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur 17 3 3 6 Jun (31%) followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out 11 0 2 ofJul the 26 actual donors (8%) had pledged to donate before and carried the 2donor card 9 2 0 2 Aug 8.10). (Table

8 0 1 1 Sep 0 0 accounting for 23% 0 Oct Cardiac disease 5was the most common cause of death, of the 3 1 2 brain of the cardiac 1death. Another 23% of brain dead donors and Nov death and 54% 9 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 1 2 3 Dec 8.12). In 2008, the 112 most common blood 13 group among the 13 13 organ donors26was group TOTAL

O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive.

Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the organ donors all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008 List of Tables Table 8.1: Number of Donations by Year, 1997-2008 ..............................................154 Table 8.2: Number of organs procured, 1997-2008...................................................155 Table 8.3: Potential Donor Referrals and Actual Donations by month, 2008 ...........155 Table 8.4: Distribution of Donors by Age, 1997-2008…………………………..…157 Table 8.5: Distribution of Donors by Gender, 1997-2008.........................................160 Table 8.6: Distribution of Donors by Ethnic Group, 1997-2008...............................162 Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table 8.8: Distribution of Donors by Nationality, 1997-2008...................................166 Table 8.9: Distribution of Donors by State, 1997-2008.............................................168 Table 8.10: Donor’s Pledged Status, 1997-2008 .......................................................169 Table 8.11: Distribution of Donors by Type, 1997-2008 ..........................................171 Table 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Table 8.13: Distribution of Organ Donors by Blood Group, 1997-2008...................174 Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 List of Figures Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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CADAVERIC ORGAN AND TISSUE DONATION CADAVERIC ORGAN AND TISSUE DONATION

CADAVERIC ORGAN AND TISSUE DONATION There was an increase in the number of potential cadaveric donors referred to the National Transplant Procurement Unit (NTPMU) nationwide from 73 the previous year to 112 in 2008. The number of actual donors remained about the same at 26 for the year, which translated to a conversion rate of 23% and a donation rate of 0.94 per million population (Table 8.1). Of these 13 (50%) were brain dead donors who donated organs and tissues which were procured in the operating theatre, while another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total 87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 pairs of heart valves and 4 sets of long bones. The number of donations throughout the year did not conform to any particular trend (Table 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors which together constitute 31% of the total number of donors (Table 8.4). Another 23% (6/26) were in their twenties which means that 54% of donors were under the age of thirty. The mean age was 30.8 years, age range 2 – 71 years. Male donors outnumber female three to one (Table 8.5). Two thirds of donors were Chinese, 23% Indian and 12% others by ethnicity (Table 8.6), 62% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur (31%) followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out of the 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 8.10). Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 8.12). In 2008, the most common blood group among the 13 organ donors was group O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the organ donors all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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Number of donors (n)

Figure 8.4: Distribution of Donors by Age, 1997-2008 List of Tables Table 8.1: Number of Donations by Year, 1997-2008 ..............................................154 Age 0-<10 years Age 10-<20 years Age 20-<30 years Table 8.2: Number of organs procured, 1997-2008...................................................155 Age 30-<40 years Age 40-<50 years 50 years Table 8.3: Potential Donor Referrals and Actual Donations by month,Age 2008 ...........155 Table358.4: Distribution of Donors by Age, 1997-2008…………………………..…157 Table 8.5: Distribution of Donors by Gender, 1997-2008.........................................160 Table308.6: Distribution of Donors by Ethnic Group, 1997-2008...............................162 Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table258.8: Distribution of Donors by Nationality, 1997-2008...................................166 Table 8.9: Distribution of Donors by State, 1997-2008.............................................168 Table208.10: Donor’s Pledged Status, 1997-2008 .......................................................169 Table 8.11: Distribution of Donors by Type, 1997-2008 ..........................................171 Table158.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Table 8.13: Distribution of Organ Donors by Blood Group, 1997-2008...................174 Table108.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 5 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 0

List of Figures 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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CADAVERIC ORGAN AND TISSUE DONATION CADAVERIC ORGAN AND TISSUE DONATION

CADAVERIC ORGAN AND TISSUE DONATION Donor's Age Group (year) in 2008

Number of donors (n)

There 6 was an increase in the number of potential cadaveric donors referred to the National Transplant Procurement Unit (NTPMU) nationwide from 73 the previous year to 112 in 2008. The number of actual donors remained about the same at 26 for the year, which translated to a conversion rate of 23% and a donation rate of 0.94 per million population (Table 8.1). Of these 13 (50%) were brain dead donors who 4 donated organs and tissues which were procured in the operating theatre, while another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total 87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 pairs of heart valves and 4 sets of long bones. The 2number of donations throughout the year did not conform to any particular trend (Table 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors which together constitute 31% of the total number of donors (Table 8.4). Another 23% (6/26) were in their twenties which means that 54% of donors were under the age of thirty. The mean age was 30.8 years, age range 2 – 71 years. Male donors 0 outnumber female three to one (Table 8.5). 30-<40 0-<10 10-<20 20-<30 40-<50 50 Donor's Age Group (Years)

Two thirds of donors were Chinese, 23% Indian and 12% others by ethnicity (Table 8.6), 62% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur (31%) followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out of the 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 8.10). Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 8.12). In 2008, the most common blood group among the 13 organ donors was group O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the organ donors all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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Table 8.5: Distribution of Donors by Gender, 1997-2008 No. (%) List of Tables Donor’s 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Total Table gender8.1: Number of Donations by Year, 1997-2008 ..............................................154 N=5 N=7 N=4 N=13 N=24 N=30 N=25 N=16 N=13 N=25 N=25 N=26 N=213 Table 8.2: Number of organs procured, 1997-2008...................................................155 3 7 3 11 20 27 21 12 8 19 20 18 169 Male 8.3: Potential Donor Referrals and Actual Donations by month, 2008 ...........155 Table (60) (100) (75) (85) (83) (90) (84) (75) (62) (76) (80) (69) (79) Table 8.4: Distribution by 2 0 1of Donors 2 4 Age,3 1997-2008…………………………..…157 4 4 5 6 5 8 44 Female (0) (25) (15) (17) (10) 1997-2008.........................................160 (16) (25) (38) (24) (20) (31) (21) Table 8.5:(40) Distribution of Donors by Gender, Table 8.6: Distribution of Donors by Ethnic Group, 1997-2008...............................162 Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Figure8.8: 8.5:Distribution DistributionofofDonors DonorsbybyNationality, Gender, 1997-2008 Table 1997-2008...................................166 Table 8.9: Distribution of Donors by State, 1997-2008.............................................168 Table 8.10: Donor’s Pledged Status, 1997-2008 .......................................................169 Table 8.11: Distribution of Donors by Type, 1997-2008 ..........................................171 Table 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Table 8.13: Distribution of Organ Donors by Blood Group, 1997-2008...................174 Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 List of Figures Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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CADAVERIC ORGAN AND TISSUE DONATION Male

Female

Number of donors (n)

There 35 was an increase in the number of potential cadaveric donors referred to the National Transplant Procurement Unit (NTPMU) nationwide from 73 the previous year30to 112 in 2008. The number of actual donors remained about the same at 26 for the year, which translated to a conversion rate of 23% and a donation rate of 0.94 per million population (Table 8.1). Of these 13 (50%) were brain dead donors who 25 donated organs and tissues which were procured in the operating theatre, while another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total 20 87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 pairs of heart valves and 4 sets of long bones. 15

The number of donations throughout the year did not conform to any particular trend 10 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors (Table which together constitute 31% of the total number of donors (Table 8.4). Another 23% 5(6/26) were in their twenties which means that 54% of donors were under the age of thirty. The mean age was 30.8 years, age range 2 – 71 years. Male donors outnumber female three to one (Table 8.5). 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Two thirds of donors were Chinese, 23% Year Indian and 12% others by ethnicity (Table

8.6), 62% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur (31%) followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out of the 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 8.10). Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 8.12). In 2008, the most common blood group among the 13 organ donors was group O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the organ donors all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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National Transplant Transplant Registry National Registry2008 2008

Table 8.6: Distribution of Donors by Ethnic Group, 1997-2008 No. (%) List of Tables Donor’s ethnic 1997 1998 1999 2000..............................................154 2001 2002 2003 Table 8.1: Number of Donations by Year, 1997-2008 group N=5 N=7 N=4 N=13 N=24 N=30 N=25 Table 8.2: Number of organs procured, 1997-2008...................................................155 Malay8.3: Potential1 Donor (20) 0 (0) (0) 2 (15) 1 (4) (0) ...........155 0 (0) Table Referrals and0 Actual Donations by month, 02008 Chinese 3 (60)of Donors 4 (57)by Age, 4 (100) 7 (54) 17 (71) 13 (43) 14 (56) Table 8.4: Distribution 1997-2008…………………………..…157 Indian 1 (20) 3 (43) 0 (0) 3 (23) 4 (17) 15 (50) 9 (36) Table 8.5: Distribution of Donors by Gender, 1997-2008.........................................160 Others8.6: Distribution 0 (0)of Donors 0 (0) by Ethnic 0 (0) Group, 1 (8) 2 (8) 2 (7) 2 (8) Table 1997-2008...............................162 Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 (%) Table 8.8:ethnic Distribution of Donors by Nationality,No. 1997-2008...................................166 Donor’s 2004 2005 2006 2007 208 Total group8.9: Distribution of Donors by State, 1997-2008.............................................168 Table N=16 N=13 N=25 N=25 N=28 N=213 Table Status, Malay8.10: Donor’s 1Pledged (6) 1 (8) 1997-2008 1 (4) .......................................................169 5 (20) 0 (0) 12 (6) Table 8.11: Distribution by Type, Chinese 14 (88)of Donors 5 (38) 121997-2008 (48) 14..........................................171 (56) 17 (65) 124 (58) Table 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Indian 1 (6) 7 (54) 11 (44) 3 (12) 6 (23) 63 (30) Table Donors by1 (4) Blood Group, Others8.13: Distribution 0 (0) of Organ 0 (0) 3 (12)1997-2008...................174 3 (12) 14 (7) Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table DistributionofofDonors Donorsby byEthnic Procurement 1997-2008 .....................178 Figure8.14c: 8.6: Distribution Group, Site, 1997-2008 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 List of Figures Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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CADAVERIC ORGAN AND TISSUE DONATION CADAVERIC ORGAN AND TISSUE DONATION

CADAVERIC ORGAN AND TISSUE DONATION Malay

Chinese

Indian

Others

Number of donors (n)

There 35 was an increase in the number of potential cadaveric donors referred to the National Transplant Procurement Unit (NTPMU) nationwide from 73 the previous year to 112 in 2008. The number of actual donors remained about the same at 26 for 30 the year, which translated to a conversion rate of 23% and a donation rate of 0.94 per million population (Table 8.1). Of these 13 (50%) were brain dead donors who 25 donated organs and tissues which were procured in the operating theatre, while another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total 87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 20 pairs of heart valves and 4 sets of long bones. 15

The number of donations throughout the year did not conform to any particular trend (Table 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors 10 which together constitute 31% of the total number of donors (Table 8.4). Another 23% (6/26) were in their twenties which means that 54% of donors were under the 5 thirty. The mean age was 30.8 years, age range 2 – 71 years. Male donors age of outnumber female three to one (Table 8.5). 0

1998 1999 2001 23% 2002 Indian 2003 2004 2005 others 2006 2007 2008 Two thirds1997 of donors were2000 Chinese, and 12% by ethnicity (Table Year 8.6), 62% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur (31%) followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out of the 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 8.10).

Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 8.12). In 2008, the most common blood group among the 13 organ donors was group O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the organ donors all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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Fifth Report of the National Transplant FifthRegistry Reportof2008 of Fifth Report thethe

National Transplant Transplant Registry National Registry2008 2008

Table 8.7: Distribution of Donors by Religion, 1997-2008 No. (%) List of Tables Donor’s 1997 1998 by Year, 1999 1997-2008 2000 ..............................................154 2001 2002 2003 Table 8.1: Number of Donations religion N=5 N=7 N=4 N=13 N=24 N=30 N=25 Table 8.2: Number of organs procured, 1997-2008...................................................155 Islam 1 (20) 0 (0) 0 (0) (15) 1 (4) (0) 1 (4) Table 8.3: Potential Donor Referrals and Actual2Donations by month,02008 ...........155 Buddhism 3 (60) 3 (43) 0 (0) 0 (0) 1 (4) 5 (17) 15 (60) Table 8.4: Distribution Hinduism 1 (20) of Donors 3 (43) by Age, 0 (0) 1997-2008…………………………..…157 3 (23) 3 (13) 13 (43) 8 (32) Table 8.5: Distribution of Donors by Gender, 1997-2008.........................................160 Christianity 0 (0) 0 (0) 0 (0) 1 (8) 0 (0) 1 (3) 1 (4) Table Others8.6: Distribution 0 (0) of Donors 0 (0) by Ethnic 0 (0) Group, 0 (0)1997-2008...............................162 0 (0) 0 (0) 0 (0) Unknown 0 (0) of Donors 1 (14) by 4Religion, (100) 7 (54) 19 (79) 11 (37) 0 (0) Table 8.7: Distribution 1997-2008.......................................164 Table 8.8: Distribution of Donors by Nationality, 1997-2008...................................166 No. (%) Table 8.9: Distribution of Donors by State, 1997-2008.............................................168 Donor’s 2004 2005 2006 2007 2008 Total Table 8.10: Donor’s Pledged Status, 1997-2008 .......................................................169 religion N=16 N=13 N=25 N=25 N=26 N=213 Table 8.11: Distribution of Donors by Type, 1997-2008 ..........................................171 Islam 2 (13) 1 (8) 2 (8) 5 (20) 0 (0) 15 (7) Table 8.12: Distribution of Death,131997-2008………………..172 Buddhism 14 (88) of Donors 5 (38) by Cause 12 (48) (52) 16 (62) 87 (41) Table 8.13: Distribution by(40) Blood Group, Hinduism 0 (0) of Organ 5 (38)Donors10 2 (8) 1997-2008...................174 6 (23) 54 (25) Table 8.14a: Distribution of Donors of Origin, Christianity 0 (0) 0 (0) by Institution 0 (0) 4 (16) 1997-2008.................176 3 (12) 10 (5) Others 0 (0) 2 (15) 0 (0) 1 (4) 0 (0) 3 (1) Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Unknown 0 (0) 0 (0) by Procurement 1 (4) 0 (0)1997-2008 1 (4) 44 (21) Table 8.14c: Distribution of Donors Site, .....................178 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 Figure 8.7: Distribution of Donors by Religion, 1997-2008 List of Figures Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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CADAVERIC ORGAN AND TISSUE DONATION CADAVERIC ORGAN AND TISSUE DONATION

CADAVERIC ORGAN AND TISSUE DONATION Islam Christianity

Buddhism Others

Hinduism Unknown

Number of donors (n)

There was an increase in the number of potential cadaveric donors referred to the National Transplant Procurement Unit (NTPMU) nationwide from 73 the previous 35 year to 112 in 2008. The number of actual donors remained about the same at 26 for the year, which translated to a conversion rate of 23% and a donation rate of 0.94 per 30 million population (Table 8.1). Of these 13 (50%) were brain dead donors who donated organs and tissues which were procured in the operating theatre, while 25 another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total 87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 20 pairs of heart valves and 4 sets of long bones. The 15 number of donations throughout the year did not conform to any particular trend (Table 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors 10 together constitute 31% of the total number of donors (Table 8.4). Another which 23% (6/26) were in their twenties which means that 54% of donors were under the age of5 thirty. The mean age was 30.8 years, age range 2 – 71 years. Male donors outnumber female three to one (Table 8.5). 0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Two thirds of donors were Chinese, 23% Indian and 12% others by ethnicity (Table Year 8.6), 62% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur (31%) followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out of the 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 8.10). Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 8.12). In 2008, the most common blood group among the 13 organ donors was group O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the organ donors all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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Table 8.8: Distribution of Donors by Nationality, 1997-2008 No. (%) List of Tables Donor’s 1997 1998 1999 2000 2001 2002 2003 ..............................................154 2004 2005 2006 2007 2008 Total Table 8.1: Number of Donations by Year, 1997-2008 nationality N=5 N=7 N=4 N=13 N=24 N=30 N=25 N=16 N=13 N=25 N=25 N=26 N=213 Table 8.2: Number of organs procured, 1997-2008...................................................155 5 7 4 13 21 29 24 16 24 204 Table 8.3: Potential Donor Referrals and Actual Donations by 13 month,24200824 ...........155 Malaysian (100) (100) (100) (100) (88) (97) (96) (100) (100) (96) (96) (92) (96) Table 1997-2008…………………………..…157 Non- 8.4: Distribution 0 0 of0Donors 0 by Age, 3 1 1 0 0 1 1 2 9 Table 8.5: Distribution of Donors by Gender, Malaysian (0) (0) (0) (0) (13) (3)1997-2008.........................................160 (4) (0) (0) (4) (4) (8) (4) Table 8.6: Distribution of Donors by Ethnic Group, 1997-2008...............................162 Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table Figure8.8: 8.8:Distribution DistributionofofDonors DonorsbybyNationality, Nationality,1997-2008...................................166 1997-2008 Table 8.9: Distribution of Donors by State, 1997-2008.............................................168 Table 8.10: Donor’s Pledged Status, 1997-2008 .......................................................169 Table 8.11: Distribution of Donors by Type, 1997-2008 ..........................................171 Table 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Table 8.13: Distribution of Organ Donors by Blood Group, 1997-2008...................174 Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 List of Figures Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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CADAVERIC ORGAN AND TISSUE DONATION Malaysian

Non-Malaysian

Number of donors (n)

There was an increase in the number of potential cadaveric donors referred to the 35 National Transplant Procurement Unit (NTPMU) nationwide from 73 the previous year to 112 in 2008. The number of actual donors remained about the same at 26 for 30 which translated to a conversion rate of 23% and a donation rate of 0.94 per the year, million population (Table 8.1). Of these 13 (50%) were brain dead donors who donated 25 organs and tissues which were procured in the operating theatre, while another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total 87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 pairs20of heart valves and 4 sets of long bones. The 15 number of donations throughout the year did not conform to any particular trend (Table 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors which together constitute 31% of the total number of donors (Table 8.4). Another 10 23% (6/26) were in their twenties which means that 54% of donors were under the age of thirty. The mean age was 30.8 years, age range 2 – 71 years. Male donors 5 outnumber female three to one (Table 8.5). Two thirds of donors were Chinese, 23% Indian and 12% others by ethnicity (Table 0 8.6), 62% 1997 were 1998 Buddhist religion (Table2003 8.7).2004 Two2005 donors 1999 by 2000 2001 2002 2006were 2007non-Malaysian 2008 (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur (31%) followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out of the 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 8.10). Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 8.12). In 2008, the most common blood group among the 13 organ donors was group O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the organ donors all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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Table 8.9: Distribution of Donors by State, 1997-2008 No. (%) List of Tables Donor’s state of Table 8.1: Number of Donations by Year, 1997-2008 ..............................................154 1997 1998 1999 2000 2001 2002 2003 residence* N=5 N=7 N=4 N=13 N=24 N=30 N=25 Table 8.2: Number of organs procured, 1997-2008...................................................155 Johor 8.3: Potential Donor 0 Referrals 0 and Actual 0 3 (23) 2 (7) ...........155 3 (12) Table Donations by 0month, 2008 Table 8.4: Distribution of by Age,1 (25) 1997-2008…………………………..…157 Malacca 0 Donors 1 (14) 0 0 1 (3) 2 (8) Table Distribution of by Gender, Negeri8.5: Sembilan 0 Donors 1 (14) 0 1997-2008.........................................160 1 (8) 0 1 (3) 4 (16) Table 8.6: Distribution of Donors by Ethnic0 Group, 1997-2008...............................162 Selangor 2 (40) 1 (14) 0 3 (13) 9 (30) 6 (24) Table 8.7: Lumpur Distribution of Donors by Religion, WP Kuala 1 (20) 1 (14) 2 (50) 1997-2008.......................................164 0 0 5 (17) 2 (8) Table 8.8: Distribution of Donors by Nationality, 1997-2008...................................166 WP Putrajaya 0 0 0 0 0 1 (3) 0 Table of Donors by State, 1997-2008.............................................168 Perak 8.9: Distribution 1 (20) 2 (29) 1 (25) 3 (23) 0 4 (13) 0 Table 8.10: Donor’s Pledged Status, 1997-2008 .......................................................169 Kedah 0 0 0 2 (15) 3 (13) 1 (3) 0 Table Perlis 8.11: Distribution0 of Donors 0 by Type, 0 1997-2008 0 ..........................................171 0 0 0 Table 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Pulau Pinang 0 0 0 1 (8) 3 (13) 1 (3) 3 (12) Table 8.13: Distribution of Organ Donors by Blood Group, 1997-2008...................174 Pahang 0 1 (14) 0 0 3 (13) 2 (7) 2 (8) Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Terengganu 0 0 0 0 1 (4) 0 0 Table 8.14b: Distribution Site, 1997-2008 Kelantan 0 of Donors 0 by Referral 0 1 (8) 0 ............................177 0 0 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 Sabah 0 0 0 2 (15) 1 (4) 0 1 (4) Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 Sarawak 0 0 0 0 0 0 0 Others**

1 (4)

List of Figures Unknown 1 (20) 0 0 0 10 (42) 3 (10) 1 (4) Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 No. (%) Donor’s state of Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 2004 2005 2006 2007 2008 Total residence* Figure 8.5: Distribution of DonorsN=13 by Gender,N=25 1997-2008N=25 .......................................160 N=16 N=26 N=213 Figure 8.6: Distribution1 of Donors1by Ethnic Group, 1997-2008..............................162 Johor (6) (8) 1 (4) 5 (20) 3 (12) 19 (9) Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Malacca 0 1 (8) 2 (8) 1 (4) 0 9 (4) Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Negeri Sembilan 0 1 (8) 2 (8) 1 (4) 2 (8) 13 (6) Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 Selangor 6 (38) 7 (54) 2 (8) 6 (24) 3 (12) 45 (21) Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 WP Kuala Lumpur 3 (19) 2 (15) 6 (24) 3 (12) 8 (31) 33 (15) Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 WP Putrajaya 0 0 0 0 0 1 (0) Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 1997Perak 2 (13) 1 (8) 4 (16) 2 (8) 3 (12) 23 (11) 2008…………………………….…………………………………....176 Kedah 1 (6) (4) 2 (8) 1 (4) Figure 8.13c: Distribution of Organ0Donor by1Blood Group Type (pie chart), 11 (5) Perlis 0 0 0 0 0 0 2008…………………………….……………………………….…...176 Pulau Pinang 2 (13)of Donors 0 by Institution 4 (16) of Origin, 2 (8) 1997-2008 2 (8) ...............176 18 (8) Figure 8.14a: Distribution Pahang8.14b: Distribution 0 of Donors 0 by Referral 1 (4)Site, 1997-2008...........................177 1 (4) 2 (8) 12 (6) Figure Terengganu 0 0 0 1 (4) 0 2 (1) Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178 Kelantan Sabah Sarawak Others** Unknown

0 1 (6) 0 0 0

0 0 0 0 0

1 (4) 0 0 1 (4) 0

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0 0 0 1 (4) 0

0 2 (8) 0 0 0

2 (1) 7 (3) 0 3 (1) 15 (7)

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Table 8.10: Donor’s Pledged Status, 1997-2008 No. (%) CADAVERIC ORGAN AND TISSUE DONATION Donor’s

pledged 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Total status N=13 N=25 N=26toN=213 N=5 anN=7 N=4 inN=13 N=24 N=30 N=25 N=16 There was increase the number of potential cadaveric donorsN=25 referred the Pledged 0 0 0 0 0 5 6 2 3 1 6 25 National Transplant Procurement Unit (NTPMU) nationwide from 73 the 2previous donors (0) (0) (0) (0) (0) (17) (24) (13) (23) (4) (24) (8) (12) year to 112 in 2008. The number of actual donors remained about the same at 26 for Non4 13 a conversion 24 25 rate19of 23% 14 and10a donation 24 19 188 the year, 5which7translated to rate of240.94 per pledged (100) (100) (100) (100) (100) (83) (76) (88) (77) (96) (76) (92) (88) million population (Table 8.1). Of these 13 (50%) were brain dead donors who donors

donated organs and tissues which were procured in the operating theatre, while another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total 87 organs tissuesPledged were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 Figure 8.10:and Donor’s Status, 1997-2008 pairs of heart valves and 4 sets of long bones.

The number of donations throughout the year did not conform to any particular trend (Table 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors which together constitute 31% of the total number of donors (Table 8.4). Another 23% (6/26) were in their twenties which means that 54% of donors were under the age of thirty. The mean age was 30.8 years, age range 2 – 71 years. Male donors outnumber female three to one (Table 8.5). Two thirds of donors were Chinese, 23% Indian and 12% others by ethnicity (Table 8.6), 62% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur (31%) followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out of the 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 8.10). Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 8.12). In 2008, the most common blood group among the 13 organ donors was group O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the organ donors all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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Number of donors (n)

List of Tables Pledged Non-Pledged Table 8.1: Number of Donations by Year, 1997-2008 ..............................................154 Table 35 8.2: Number of organs procured, 1997-2008...................................................155 Table 8.3: Potential Donor Referrals and Actual Donations by month, 2008 ...........155 Table 8.4: Distribution of Donors by Age, 1997-2008…………………………..…157 Table 30 8.5: Distribution of Donors by Gender, 1997-2008.........................................160 Table 8.6: Distribution of Donors by Ethnic Group, 1997-2008...............................162 Table 25 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table 8.8: Distribution of Donors by Nationality, 1997-2008...................................166 Table 20 8.9: Distribution of Donors by State, 1997-2008.............................................168 Table 8.10: Donor’s Pledged Status, 1997-2008 .......................................................169 Table 8.11: Distribution of Donors by Type, 1997-2008 ..........................................171 Table 15 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Table 8.13: Distribution of Organ Donors by Blood Group, 1997-2008...................174 Table 10 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 5 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 List of 0Figures 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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Table 8.11: Distribution of Donors by Type, 1997-2008 No. (%) CADAVERIC ORGAN AND TISSUE DONATION Type of

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Total N=5 anN=7 N=4 in N=13 N=30 N=25 N=16 N=13 N=25 N=25referred N=26 N=213 There was increase the N=24 number of potential cadaveric donors to the BD National Transplant Procurement Unit (NTPMU) nationwide from 73 the previous (Brain 4 6 4 11 20 17 8 10 5 14 15 13 127 year to 112 2008. The (85) number remained Death (80) in(86) (100) (83)of actual (57) donors (32) (63) (38) about (56) the (60) same (50) at 26 (60)for the year, which translated to a conversion rate of 23% and a donation rate of 0.94 per donor) million population (Table 8.1). Of these 13 (50%) were brain dead donors who CD (tissue donated organs and tissues which were procured in the operating theatre, while donors 1 were 1 tissue 0 donations 2 4 after13 17 death 6 (Table 8 8.2, 11 Table 10 8.11). 13 In 86 another 13 cardiac total after (20) (14) (0) (15) (17) (43) (68) (38) (62) (44) (40) (50) (40) 87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 Cardiac pairs of heart valves and 4 sets of long bones. Death)* *CD involve tissue donations only. donors

The number of donations throughout the year did not conform to any particular trend (Table8.11: 8.3).Distribution There wereof4 Donors paediatric donors1997-2008 (age 1 – 9 years) and 4 teenage donors Figure by Type, which together constitute 31% of the total number of donors (Table 8.4). Another 23% (6/26) were in their twenties which means that 54% of donors were under the age of thirty. The BD mean age wasCD 30.8 years, age range 2 – 71 years. Male donors outnumber female three to one (Table 8.5). 35

Number of donors (n)

Two thirds of donors were Chinese, 23% Indian and 12% others by ethnicity (Table 8.6),3062% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur 25 followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out (31%) of the 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 20 8.10). Cardiac disease was the most common cause of death, accounting for 23% of the brain15death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 10 In 2008, the most common blood group among the 13 organ donors was group 8.12). O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) 5from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. 0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

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List of Tables Table 8.1: Number of Donations by Year, 1997-2008 ..............................................154 Table 8.2: Number of organs procured, 1997-2008...................................................155 Table 8.3: Potential Donor Referrals and Actual Donations by month, 2008 ...........155 Table 8.4: Distribution of Donors by Age, 1997-2008…………………………..…157 Table 8.5: Distribution of Donors by Gender, 1997-2008.........................................160 Table 8.6: Distribution of Donors by Ethnic Group, 1997-2008...............................162 Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table 8.8: Distribution of Donors by Nationality, 1997-2008...................................166 Table 8.9: Distribution of Donors by State, 1997-2008.............................................168 Table 8.10: Donor’s Pledged Status, 1997-2008 .......................................................169 Table 8.11: Distribution of Donors by Type, 1997-2008 ..........................................171 Table 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Table 8.13: Distribution of Organ Donors by Blood Group, 1997-2008...................174 Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179 List of Figures Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178

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Table 8.13: Distribution of Organ Donors by Blood Group, 1997-2008 No. (%) List of Tables Blood 8.1: groupNumber1997 1998by Year, 1999 2000..............................................154 2001 2002 2003 Table of Donations 1997-2008 N=4 N=6 N=4 N=11 N=20 N=15 N=7 Table 8.2: Number of organs procured, 1997-2008...................................................155 A positive 1 (25) 2 (33) 0 (0) 1 (9) 5 (25) 4 (27) 4 (57) Table 8.3: Potential Donor Referrals and Actual Donations by month, 2008 ...........155 B positive 0 (0) 1 (17) 1 (25) 5 (45) 4 (20) 4 (27) 2 (29) Table 8.4: Distribution of Donors by Age, 1997-2008…………………………..…157 AB positive 1 (25) 1 (17) 0 (0) 0 (0) 1 (5) 0 (0) 0 (0) Table 8.5: Distribution of Donors by Gender, 1997-2008.........................................160 O positive 2 (50) 2 (33) 3 (75) 5 (45) 10 (50) 7 (47) 1 (14) Table 8.6: Distribution of Donors by Ethnic Group, 1997-2008...............................162 A negative 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table 8.8: Distribution of Donors by Nationality, 1997-2008...................................166 No. (%) Table of Donors by State, 1997-2008.............................................168 Blood 8.9: groupDistribution 2004 2005 2006 2007 2008 Total Table 8.10: Donor’sN=10 Pledged Status, 1997-2008 .......................................................169 N=5 N=14 N=15 N=13 N=124 Table 8.11: Distribution 1997-20086..........................................171 A positive 2 (20) of Donors 1 (20)by Type,4 (29) (40) 4 (31) 34 (27) B positive 4 (40) of Donors 2 (40)by Cause 5 (36) 3 (20) 2 (15) 33 (27) Table 8.12: Distribution of Death, 1997-2008………………..172 AB positive 0 (0) of Organ 0 (0) 2 (14) 0 (0)1997-2008...................174 0 (0) 5 (4) Table 8.13: Distribution Donors by Blood Group, O positive 4 (40) 2 (40) 3 (21) 5 (33) 6 (46) 50 (40) Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 A negative 0 (0) 0 (0) 0 (0) 1 (7) 1 (8) 2 (2) Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Blood group is only ascertained in brain dead donors and is not done for tissue donors post -cardiac deaths Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179

Number of donors (n)

Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 List of Figures Figure 8.1: Number of Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor A+ Referrals and B+ Actual Donations AB+ by month, 2008..……156 Figure 8.4: DistributionO+of Donors by Age, A- 1997-2008.............................................158 Figure 8.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure208.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure 8.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure188.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure168.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure148.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 199712 2008…………………………….…………………………………....176 Figure108.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 8 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 6 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178 4 2 0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

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Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 1997Figure 8 8.13b: Distr ributionAND of Organ O TISSUE Dono or by Bloodd Group Typpe (pie charrt), 1997-20 008 2008 CADAVERIC ORGAN DONATION There was an increase in the number oftive potential cadaveric donors referred to the A Nega National Transplant Procurement Unit2%(NTPMU) nationwide from 73 the previous year to 112 in 2008. The number of actual donors remained about the same at 26 for A P Positive O which translated to a conversion rate of 23% and a donation O Positive the year, 27% rate of 0.94 per 40% million population (Table 8.1). Of these 13 (50%) were brain dead donors who donated organs and tissues which were procured in the operating theatre, while another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total 87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 pairs of heart valves and 4 sets of long bones. The number of donations throughout the year did not conform to any particular trend (Table 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors which together constitute 31% of the total number of donors (Table 8.4). Another 23% (6/26) were in their twenties which means that 54% of donors were under the age of thirty. The mean age was 30.8 years, age range 2 – 71 years. Male donors B Positive outnumber female three to one (Table 8.5). 27% AB Positive A Two thirds of donors4%were Chinese, 23% Indian and 12% others by ethnicity (Table

Figure 8.13c: 8 Distrribution of Organ O Donoor by Bloodd Group Typpe (pie charrt), 2008 Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% of the cardiac death. Another 23% of brain dead donors and Negative 15% of post-cardiac death A tissue donors died from motor vehicle accidents (Table 8% 8.12). In 2008, the most common blood group among the 13 organ donors was group A P Positive 31% (15%), only 1 O rhesus positive (46%), followed by A positive (31%), B positive (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). B Possitive Organ donors were sent to the operating theatre for procurement of organs (13/13) 15 % while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the O Positive O organ donors 46% all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13)AB Positive A (Table 8.15). 0%

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Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 No. (%) List of Tables Donors’ Institution of 1997 1998 1999 2000 2001 2002 2003 Table 8.1: Number of Donations by Year, 1997-2008 ..............................................154 Origin N=5 N=7 N=4 N=13 N=24 N=30 N=25 Table 8.2: Number of organs procured, 1997-2008...................................................155 MOH8.3: state/general hospitals 2 (40) 5and (71)Actual 1 (25) 10 (77)by 16 (67) 2008 19 (63) 15 (60) Table Potential Donor Referrals Donations month, ...........155 MOH district hospitals 0 (0) 0 (0) 0 (0) 2 (15) 0 (0) 3 (10) 4 (16) Table 8.4: Distribution of Donors by Age, 1997-2008…………………………..…157 University hospitals 1 (20) 1 (14) 0 (0) 0 (0) 6 (25) 3 (10) 3 (12) Table 8.5: Distribution of Donors Private hospitals 1 (20) by 1Gender, (14) 31997-2008.........................................160 (75) 1 (8) 2 (8) 4 (13) 3 (12) Table Group, Home8.6: Distribution of Donors 1 (20) by Ethnic 0 (0) 0 (0) 1997-2008...............................162 0 (0) 0 (0) 1 (3) 0 (0) Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table 8.8: Distribution of Donors by Nationality, 1997-2008...................................166 No. (%) Donors’ Institution of Table 8.9: Distribution of Donors 2004 by State, 20051997-2008.............................................168 2006 2007 2008 Total Origin N=16 1997-2008 N=13 N=25 N=25 N=26 N=213 Table 8.10: Donor’s Pledged Status, .......................................................169 MOH8.11: state/general hospitalsof Donors 12 (75) by Type, 8 (62) 1997-2008 20 (80) ..........................................171 18 (72) 15 (58) 141 (66) Table Distribution MOH district hospitals 2 (13) 0 (0) 0 (0) 3 (12) 0 (0) 14 (7) Table 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 University hospitals 1 (6) 1 (8) 3 (12) 2 (8) 3 (12) 24 (11) Table 8.13: Distribution of Organ by Blood Group, 1997-2008...................174 Private hospitals 1 (6) Donors 4 (31) 2 (8) 2 (8) 6 (23) 30 (14) Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Home 0 (0) 0 (0) 0 (0) 0 (0) 2 (8) 4 (2) Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table 1997-2008 .....................178 Figure8.14c: 8.14a:Distribution DistributionofofDonors DonorsbybyProcurement Institution ofSite, Origin, 1997-2008 Table 8.15: Distribution of Donors by Inotrope, 2008 ..............................................179

Number of donors (n)

MOH state/G. Hospitals MOH district hospitals List of Figures hospitals Private hospitals Figure 8.1: Number ofUniversity Donations by Year, 1997-2008 .............................................154 Home (eye donors only) Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure358.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure308.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure258.10: Donor’s Pledged Status, 1997-2008......................................................169 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure208.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure 8.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 199715 2008…………………………….…………………………………....176 Figure 8.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 10 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 5 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178 0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

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Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 No. (%) CADAVERIC ORGAN AND TISSUE DONATION Donor Referral Site

1997 1998 1999 2000 2001 2002 2003 N=5 N=7 N=4 N=13 N=24 N=30 N=25 There was an increase in the number of potential cadaveric donors referred to the ICU 1 (20) 0 (0)Unit (NTPMU) 0 (0) 1 nationwide (8) 14 (58)from 1673 (53)the 13 (52) National Transplant Procurement previous Ward 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (3) 3 (12) year to 112 in 2008. The number of actual donors remained about the same at 26 for Emergency department 0 (0) 0 (0) 0 (0) 0 (0) 3 (13) 4 (13) 1 (4) the year, which translated rate of 60.94 Mortuary 0 (0)to a conversion 0 (0) 0 rate (0) of 23% 0 (0) and a0 donation (0) 3 (10) (24) per million population (Table 8.1). Of these 13 (50%) were brain dead donors Home 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 1 (3) 0 (0)who donated organs and tissues procured in the7 (29) operating theatre,2 (8) while Data not available 4 (80) which 7 (100) were 4 (100) 12 (92) 5 (17)

another 13 were tissue donations after cardiac death (Table 8.2, Table 8.11). In total 87 organs and tissues were procured, comprisingNo. 40(%) corneas, 26 kidneys, 4 livers, 13 Donor Referral Site pairs of heart valves and2004 4 sets of long bones. 2005 2006 2007 2008 Total

N=16 N=13 N=25 N=25 N=26 N=213 ICU 12 (75) 8 (62) 16 (64) 17 (68) 17 (65) 115 The number of donations throughout the year did not conform to any particular(54) trend Ward 1 (6) 3 (23) 3 (12) 1 (4) 3 (12) 15 (7) (Table 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors Emergency department 0 (0) 0 (0) 3 (12) 1 (4) 1 (4) 13 (6) which together constitute 31% of1 the total 3number of5 donors (Table 8.4).25Another Mortuary 3 (19) (8) (12) (20) 4 (15) (12) 23% (6/26) were in their twenties which means that 54% of donors were under Home 0 (0) 0 (0) 0 (0) 0 (0) 1 (4) 2 (1) the age not of available thirty. The mean0 (0) age was 130.8 age range 2 – 71 years. donors Data (8) years,0 (0) 1 (4) 0 (0) Male 43 (20)

outnumber female three to one (Table 8.5).

Two thirds donors were IndianSite, and1997-2008 12% others by ethnicity (Table Figure 8.14b:ofDistribution of Chinese, Donors by23% Referral 8.6), 62% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur ICU Emergency (31%) followed by Johor, Selangor andWard Perak (12% each) (Tabledepartment 8.9). Only two out of the 26 actual donors (8%) had pledged to donate before and carried the donor card Not available Mortuary Home (Table 8.10). 35

Number of donors (n)

Cardiac disease was the most common cause of death, accounting for 23% of the brain30death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 8.12). In 2008, the most common blood group among the 13 organ donors was group 25 O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality 20 since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive.

Most15of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent 10 of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). 5

Organ donors were sent to the operating theatre for procurement of organs (13/13) while0tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the 1997all1998 2000 2001 2002 before 2003 2004 2005 2006 2008 organ donors were 1999 on inotropic support procurement with2007 the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 No. (%) List of Tables Donor Procurement 1997 1998 1999 2000 2001 2002 2003 Table 8.1: Number of Donations by Year, 1997-2008 ..............................................154 Site N=5 N=7 N=4 N=13 N=24 N=30 N=25 Table 8.2: Number of organs procured, 1997-2008...................................................155 Operation theatre Donor 4 (80) 6 (86) 4 (100) Donations 11 (85) by 20month, (83) 14 (47)...........155 8 (32) Table 8.3: Potential Referrals and Actual 2008 Mortuary 0 (0) 1 (14) 0 (0) 2 (15) 3 (13) 14 (47) 14 (56) Table 8.4: Distribution of Donors by Age, 1997-2008…………………………..…157 Ward 0 (0) 0 (0) 0 (0) 0 (0) 1 (4) 1 (3) 3 (12) Table 8.5: Distribution of Donors 0by(0)Gender, 1997-2008.........................................160 Home 1 (20) 0 (0) 0 (0) 0 (0) 1 (3) 0 (0) Table of0 Donors 1997-2008...............................162 Data8.6: not Distribution available (0) 0by (0)Ethnic0 Group, (0) 0 (0) 0 (0) 0 (0) 0 (0) Table 8.7: Distribution of Donors by Religion, 1997-2008.......................................164 Table 8.8: Distribution of Donors by Nationality, 1997-2008...................................166 No. (%) Donor Procurement Table 8.9: Distribution of2004 Donors by2005 State, 1997-2008.............................................168 2006 2007 2008 Total Site N=16Status,N=13 N=25 N=26 N=213 Table 8.10: Donor’s Pledged 1997-2008N=25 .......................................................169 Operation theatre 9 (56) 5 (38) 14 (56) 16 (64) 13 (50) 124 (58) Table 8.11: Distribution of Donors by Type, 1997-2008 ..........................................171 Mortuary 7 (44) 5 (38) 10 (40) 7 (28) 12 (46) 75 (35) Table 8.12: Distribution of Donors by Cause of Death, 1997-2008………………..172 Ward 0 (0) 2 (15) 1 (4) 2 (8) 0 (0) 10 (5) Table 8.13: Distribution of0 (0) Organ Donors by Blood Group,0 (0) 1997-2008...................174 Home 0 (0) 0 (0) 1 (4) 3 (1) Table 8.14a: Distribution of Donors by Institution of Origin, 1997-2008.................176 Data not available 0 (0) 1 (8) 0 (0) 0 (0) 0 (0) 1 (0) Table 8.14b: Distribution of Donors by Referral Site, 1997-2008 ............................177 Table 8.14c: Distribution of Donors by Procurement Site, 1997-2008 .....................178 Table Distribution of of Donors byby Inotrope, 2008 ..............................................179 Figure8.15: 8.14c: Distribution Donors Procurement Site, 1997-2008

Number of donors (n)

List of Figures theater Mortuary Ward Figure 8.1: Number ofOperation Donations by Year, 1997-2008 .............................................154 Figure 8.3: Potential Donor Referrals and Actual Donations by month, 2008..……156 Not available Home Figure 8.4: Distribution of Donors by Age, 1997-2008.............................................158 Figure358.5: Distribution of Donors by Gender, 1997-2008 .......................................160 Figure 8.6: Distribution of Donors by Ethnic Group, 1997-2008..............................162 Figure308.7: Distribution of Donors by Religion, 1997-2008 .....................................164 Figure 8.8: Distribution of Donors by Nationality, 1997-2008 .................................166 Figure 8.10: Donor’s Pledged Status, 1997-2008......................................................169 25 Figure 8.11: Distribution of Donors by Type, 1997-2008 .........................................171 Figure 8.13a: Distribution of Organ Donors by Blood Group, 1997-2008 ...............174 Figure208.13b: Distribution of Organ Donor by Blood Group Type (pie chart), 19972008…………………………….…………………………………....176 Figure158.13c: Distribution of Organ Donor by Blood Group Type (pie chart), 2008…………………………….……………………………….…...176 Figure 8.14a: Distribution of Donors by Institution of Origin, 1997-2008 ...............176 10 Figure 8.14b: Distribution of Donors by Referral Site, 1997-2008...........................177 Figure 8.14c: Distribution of Donors by Procurement Site, 1997-2008....................178 5 0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

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Table 8.15: Distribution of Donors by Inotrope, 2008 CADAVERIC ORGAN AND TISSUE DONATIONNo. (%) Inotrope Dopamine

2 (15)

There was an increase in the number of potential cadaveric Dopamine/Noradrenaline 6 (46) donors referred to the National Transplant Procurement Unit (NTPMU) nationwide from 73 the previous Dopamine/Adrenaline 2 (15) year to 112 in 2008. The number of actual donors remained about the same at 26 for Dopamine/Dobutamine/Adrenaline 1 (8) the year, which translated to a conversion rate of 23% and a donation rate of 0.94 per Dopamine/Dobutamine/Adrenaline/Noradrenaline 1 (8) million population (Table 8.1). Of these 13 (50%) were brain dead donors who Missing 1 (8) donated organs and tissues which were procured in the operating theatre, while Total 13 (100)8.2, Table 8.11). In total another 13 were tissue donations after cardiac death (Table 87 organs and tissues were procured, comprising 40 corneas, 26 kidneys, 4 livers, 13 pairs of heart valves and 4 sets of long bones. The number of donations throughout the year did not conform to any particular trend (Table 8.3). There were 4 paediatric donors (age 1 – 9 years) and 4 teenage donors which together constitute 31% of the total number of donors (Table 8.4). Another 23% (6/26) were in their twenties which means that 54% of donors were under the age of thirty. The mean age was 30.8 years, age range 2 – 71 years. Male donors outnumber female three to one (Table 8.5). Two thirds of donors were Chinese, 23% Indian and 12% others by ethnicity (Table 8.6), 62% were Buddhist by religion (Table 8.7). Two donors were non-Malaysian (Table 8.8). Majority of the donors came from the Federal Territory of Kuala Lumpur (31%) followed by Johor, Selangor and Perak (12% each) (Table 8.9). Only two out of the 26 actual donors (8%) had pledged to donate before and carried the donor card (Table 8.10). Cardiac disease was the most common cause of death, accounting for 23% of the brain death and 54% of the cardiac death. Another 23% of brain dead donors and 15% of post-cardiac death tissue donors died from motor vehicle accidents (Table 8.12). In 2008, the most common blood group among the 13 organ donors was group O rhesus positive (46%), followed by A positive (31%), B positive (15%), only 1 (8%) from group A negative and no AB group (Table 8.13). When considered in totality since 1997, blood group O positive remained the most common group (40%) followed by B positive and A positive. Most of the donations (58%) took place in Ministry of Health hospitals with 6 (23%) from private hospitals and 3 (12%) from University hospitals (Table 8.14a). Sixty-five percent of the donors were found in the ICU, but there were also four direct referrals for tissue donation from the mortuary with three from the ward and one from emergency department (“brought in dead” BID) (Table 8.14b). Organ donors were sent to the operating theatre for procurement of organs (13/13) while tissues were mainly procured in the mortuary (12/13) (Table 8.14c). For the organ donors all were on inotropic support before procurement with the commonest combination being dopamine and noradrenaline (6/13) (Table 8.15).

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APPENDIX A APPENDIX A

APPENDIX A APPENDIX A DATA MANAGEMENT DATA MANAGEMENT Data integrity of a register begins from the data source, data collection tools, data verification entry begins process.from Registry datasource, is never as collection perfect as tools, the clinical Data integrityand of data a register the data data data trial data. Caution should be used when interpreting the result. verification and data entry process. Registry data is never as perfect as the clinical trial data. Caution should be used when interpreting the result. The data management personnel in the Register are trained based on the standard operating procedure (SOP). The in data process also designed enhance data The data management personnel theentry Register are istrained based onto the standard quality. Quality assurance procedures are in place at all stages to ensure the quality operating procedure (SOP). The data entry process is also designed to enhance dataof data. Quality assurance procedures are in place at all stages to ensure the quality of quality. data. The NTR maintains different databases for each of the organs i.e. blood and marrow transplant, bone and tissue transplant, cornea heart lung The NTR maintains different databases for each transplant, of the organs i.e.and blood andtransplant, marrow kidney transplant and liver transplant. Depending on the volume of data, each organâ&#x20AC;&#x2122;s transplant, bone and tissue transplant, cornea transplant, heart and lung transplant, data were stored and in either or SQL 2000.of data, each organâ&#x20AC;&#x2122;s kidney transplant liver Microsoft transplant.Access Depending on Server the volume data were stored in either Microsoft Access or SQL Server 2000. Registry ICT infrastructure and data centre The operations of the NTRand aredata supported Registry ICT infrastructure centre by an extensive ICT infrastructure to ensure operational efficiency and are effectiveness. The operations of the NTR supported by an extensive ICT infrastructure to ensure operational efficiency and effectiveness. NTR subscribes to co-location service with a high availability and highly secured data centre at Cyberjaya and at Jalan Pahang, Lumpur. This in order to provide NTR subscribes to co-location service with aKuala high availability andishighly secured data NTR at with quality assured internet hosting services and state-of-the-art and centre Cyberjaya and at Jalan Pahang, Kuala Lumpur. This is in orderphysical to provide logical security to invest in and costly data centre setup internally. NTR with qualityfeatures assuredwithout internethaving hosting services state-of-the-art physical and State-of-the-art physical security features implemented includes anti-static raised logical security features without having to invest in costly data centre setup internally. flooring, fire protection with smoke andimplemented heat alarm warning State-of-the-art physical security features includes system, anti-staticbiometric raised security access, video camera surveillance system, uninterrupted power supply, flooring, fire protection with smoke and heat alarm warning system, biometric environmental security access,control. video camera surveillance system, uninterrupted power supply, environmental control. Other managed security services include patch management of the servers, antivirus signature monitoring update,include firewall traffic monitoringofand detection, Other managed securityand services patch management theintrusion servers, antivirus security incidence data firewall backup service done on a daily, weekly and monthly signature monitoringresponse, and update, traffic monitoring and intrusion detection, basis, data recovery simulation to verify that backup is and donemonthly at least security incidence response, data backup service done on works a daily,which weekly once yearly, network security scan and penetration test done on a half-yearly basis, basis, data recovery simulation to verify that backup works which is done at least security policy maintenance, maintenance and monitoring trail. Managed once yearly, network security scan and penetration test doneofonaudit a half-yearly basis, system services are also provided such as usage and performance report, operating security policy maintenance, maintenance and monitoring of audit trail. Managed systemservices maintenance monitoring, bandwidth andreport, systems health system are alsoand provided such as usage andmonitoring performance operating monitoring. system maintenance and monitoring, bandwidth monitoring and systems health monitoring. Data sources SDPs or Source Data Providers of the National Transplant Registry comprise of Data sources centres various throughout Malaysia. Bonecomprise and tissue SDPs or for Source Data transplanted Providers of organs the National Transplant Registry of transplant, cornea transplant, kidney transplant and liver transplant SDPs submit Case centres for various transplanted organs throughout Malaysia. Bone and tissue Report Forms (CRFs) to NTR. Blood and marrow transplant (BMT) heart and transplant, cornea transplant, kidney transplant and liver transplant SDPs and submit Case lung transplant (HLT) SDPs submit data via web applications NTR-BMT and NTRReport Forms (CRFs) to NTR. Blood and marrow transplant (BMT) and heart and HLTtransplant respectively. lung (HLT) SDPs submit data via web applications NTR-BMT and NTRHLT respectively. 180 180

Fifth Report of the National Transplant Registry 2008 Fifth Report of the

APPENDIX A APPENDIX A

National Transplant Registry 2008

For the purpose of verifying patientâ&#x20AC;&#x2122;s outcome regarding death and lost to follow-up, NTR uses data from the National Vital Registration System.

Data Flow Process This section describes the data management flow process of the National Transplant Registry. ce, data collection tools, data 1) SDP 10) Query never as perfect as the clinical e result.

trained based on the standard also designed to enhance data l stages to ensure the quality of

organs i.e. blood and marrow ant, heart and lung transplant, e volume of data, each organâ&#x20AC;&#x2122;s ver 2000.

ve ICT infrastructure to ensure

2) Data reporting by SDP & Tracking Submission.

3) Visual review, Data Entry, Data Editing

4) Edit Checks Run

5) Data review and coding

6) Expert Panel Review

7) Final Query resolution / data cleaning (if any)

8) Database lock

ability and highly secured data ur. This is in order to provide 9) Data analysis and report writing d state-of-the-art physical and tly data centre setup internally. ed includes anti-static raised m warning system,SDP biometric Data reporting and Submission tracking uninterrupted power supply, Data reporting by SDP is done via Case Report Forms or Web Applications e-Case Report Forms. Different types of forms are used for different organs/tissues.

ement of the servers, Forantivirus blood and marrow transplant, NTR collects data via Blood and Marrow toring and intrusionTransplant detection, Notification Form and Blood and Marrow Ad Hoc Event Notification on a daily, weekly and monthly Form through web application NTR-BMT. Data collected from NTR-BMT is works which is done at least daily to a master database in CRC to track data submission and generate synchronised st done on a half-yearly basis, queries to site. All retrospective data was mapped and transferred to the current oring of audit trail.system. Managed performance report, operating onitoring and systems health For bone and tissue transplant, NTR collects data via Bone and Tissue Transplant Notification Form.

For cornea transplant, NTR collects data via Cornea Transplant Notification Form and nsplant Registry comprise of Cornea Transplant Outcome Form. Malaysia. Bone and tissue r transplant SDPs submit Caseand lung transplant, NTR collects data via Malaysian Heart and Lung For heart ansplant (BMT) andTransplant heart andNotification Form and Malaysian Heart and Lung Transplant Follow-Up ications NTR-BMTForm and NTRthrough web application NTR-HLT. Data collected from NTR-HLT is

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Fifth Report of the National Report Transplant Registry 2008 FifthFifth Report of theof the National Transplant Registry National Transplant Registry 2008 2008

APPENDIX A APPENDIX A

synchronised daily to a master database in NTR to track data submission and generate queries to site. APPENDIX A For kidney transplant, NTR collects data via Renal Transplant Notification Form and Renal MANAGEMENT Transplant Outcome Form. For annual survey purposes, NTR also collects data DATA via Renal Transplant Annual Return Form and Renal Transplant Annual Quality of Life integrity and Rehabilitation To further ensure timeliness Data of a register Assessment begins from Form. the data source, data collection tools, dataof notification, any patient who has been notified to National Renal Registry verification and data entry process. Registry data is never as perfect as the clinicalas transplanted will be automatically flagged to NTR. the Similarly, trial data. Caution should be used when interpreting result. NTR also automatically flags to NRR if there’s a patient with graft failure. The data management personnel in the Register are trained based on the standard For liver procedure transplant, (SOP). NTR collects dataentry via Liver Transplant Notification Form. data operating The data process is also designed to enhance quality. Quality assurance procedures are in place at all stages to ensure the quality of Data submissions by SDPs of Bone and Tissue, Cornea, Kidney and Liver Transplant data. were tracked by NTR Computer System collectively. The NTR maintains different databases for each of the organs i.e. blood and marrow Visual review be performed check transplant, for completeness and lung obvious errors or transplant, bonewill andthen tissue transplant, tocornea heart and transplant, problems. Dataand without obvious problems were entered into the relevant NTR kidney transplant liver transplant. Depending on the volume of data, each organ’s organ’s system. Data entry will not be performed if a critical variable on the CRF is data were stored in either Microsoft Access or SQL Server 2000. missing or ambiguous. The CRF is returned to the SDP for verification. Prior to registering a verification Registry ICTpatient, infrastructure and data process centre is done to ensure there are no duplicate patients and/orofnotifications. After verification, data is then into the The operations the NTR are supported by an extensive ICT entered infrastructure to relevant ensure NTR organefficiency system. and effectiveness. operational There are a fewtoin-built functionalities data entry page serve to improve NTR subscribes co-location service withatathe high availability andthat highly secured data data quality. One such function is auto calculation functionality to reduce error centre at Cyberjaya and at Jalan Pahang, Kuala Lumpur. This is in order to provideof human There is also inconsistency check functionality physical that disables NTR withcalculation. quality assured internet hosting services and state-of-the-art and certain fields if they are answered in a certain manner. When value entered is out logical security features without having to invest in costly data centre setup internally.of range, user is prompted correctfeatures value. implemented includes anti-static raised State-of-the-art physical for security flooring, fire protection with smoke and heat alarm warning system, biometric Real time reports are camera also provided in the system, web application. The aggregated data security access, video surveillance uninterrupted power supply, reports are presented environmental control.in the form of tables and graphs. The aggregated data reports are typically presented in two manners, one as centre’s own data aggregated data report and second registry’s overall aggregated data report.ofEach participating site Other managedassecurity services include patch management the servers, antivirus submitting data via the application therefore able to compare itself detection, against the signature monitoring andweb update, firewallistraffic monitoring and intrusion overall incidence registry’s response, average. data backup service done on a daily, weekly and monthly security basis, data recovery simulation to verify that backup works which is done at least Visual Review, Datasecurity Entry, Data once yearly, network scan Editing and penetration test done on a half-yearly basis, Data received by the NTR was logged and in and manually check for security policy maintenance, maintenance monitoring of reviewed audit trail.to Managed completeness errors such or problems. without obvious problems was system servicesand are obvious also provided as usageData and performance report, operating entered into the relevant NTR’s organ transplant system. Data with problems was sent system maintenance and monitoring, bandwidth monitoring and systems health to SDP as queries. As data for kidney transplant is inter-related with National Renal monitoring. Registry’s patient data, an additional verification process is performed to ensure no duplicate patient and renal replacement therapy is reported. Data sources SDPs or Source Data Providers of the National Transplant Registry comprise of Edit Check Run centres for various transplanted organs throughout Malaysia. Bone and tissue Edit checks were transplant, performed kidney periodically to identify missing data, out of submit range values, transplant, cornea transplant and liver transplant SDPs Case inconsistent data, invalid values and error with duplication. Data cleaning is then Report Forms (CRFs) to NTR. Blood and marrow transplant (BMT) and heart and performed based on the results of edit discrepancies that were lung transplant (HLT) SDPs submit datachecks. via webData applications NTR-BMT andresolved NTRwere then entered into the system. Data update and data checking of the dataset is HLT respectively. 182 180

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APPENDIX A APPENDIX A

National Transplant Registry 2008

performed when there is a query of certain fields when necessary. It could be due to request by user, correction of data based on checking from data query or after receiving results for preliminary data analysis. Any data discrepancy found is verified against the source CRF and resolved within the Register office where possible. Otherwise the specific data query report will be generated and forwarded to the SDP to clarify and resolve the data discrepancy. Data standardisation process is also done missing ce, data collectionfor tools, data data based on derivation from existing data. never as perfect as the clinical Data Review and Coding e result. Data coding of retrospective data and free text data was performed by registry manager and further verified by expert panel member. The expert panel comprising of trained based on the standard members with expertise and knowledge in the relevant area provided the quality also designed to enhance data control l stages to ensure the qualityonof the assessment of coding by data manager. They ensure that complex medical data are reviewed and assessed to detect clinical nuances in the data.

Final Query Resolution / Data Cleaning / Database Lock organs i.e. blood and marrow A final edit check run was performed to ensure that data is clean. All queries were ant, heart and lung transplant, resolved before the database is locked to ensure data quality and integrity. Data is e volume of data, each organâ&#x20AC;&#x2122;s subsequently exported to the statistician for analysis. ver 2000.

Data Release Policy One of the primary objectives of the Registry is to make data available to the ve ICT infrastructure to ensure transplant community. The Registry would appreciate that users acknowledge the Registry for the use of the data. Any request for data that requires a computer run must bedata made in writing (by e-mail, fax, or registered mail) accompanied with a Data ability and highly secured Release Application Form and signed Data Release Agreement Form. These requests ur. This is in order to provide need prior d state-of-the-art physical andapproval by the NTR Steering Committee before data can be released. tly data centre setup internally. Distribution ed includes anti-static raised of Report The MST m warning system, biometrichas made a grant towards the cost of running the registry and report printing. It is available on the website www.mst.org.my. uninterrupted power supply,

ement of the servers, antivirus toring and intrusion detection, on a daily, weekly and monthly works which is done at least st done on a half-yearly basis, oring of audit trail. Managed performance report, operating onitoring and systems health

nsplant Registry comprise of Malaysia. Bone and tissue r transplant SDPs submit Case ansplant (BMT) and heart and ications NTR-BMT and NTR-

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APPENDIX B APPENDIX B

APPENDIX B APPENDIX B STATISTICAL METHODS FOR NTR STATISTICAL METHODS FOR NTR The statistical methods described were used to summarise the data collected from the National Transplant These analyses were generated forfrom different The statistical methods Registry described(NTR). were used to summarise the data collected the types of transplant, such as bone and marrow, bone and tissue, cornea, heart and lung, National Transplant Registry (NTR). These analyses were generated for different liverofand kidney. such as bone and marrow, bone and tissue, cornea, heart and lung, types transplant, liver and kidney. 1. Overall stock and flow tables summarised transplant activity in Malaysia. Places and 1. The Overall centres transplant activities were also reported.activity Treatment rate was calculated The stockofand flow tables summarised transplant in Malaysia. Places andby the ratio of the count of number of new patients or prevalent patients in a given by year centres of transplant activities were also reported. Treatment rate was calculated the mid-year population of of Malaysia in thatoryear, and expressed per millionthetoratio of the count of number new patients prevalent patients inina given year population. Annual death rates are calculated by dividing the number of deaths in a to the mid-year population of Malaysia in that year, and expressed in per millionyear by the estimated mid-year patient population. population. Annual death rates are calculated by dividing the number of deaths in a year by the estimated mid-year patient population. 2. Recipient’s Characteristics information on recipient’s characteristics was summarised in this section. These 2. The Recipient’s Characteristics tables included the recipient’s age, gender,was ethnic group, serology data, primary The information on recipient’s characteristics summarised in this section. These disease(s), indication for transplantation, current immunosuppressive drug(s) tables included the recipient’s age, gender, ethnic group, serology data, primary treatment, etc. For summarising continuous data, the mean, standard deviation, disease(s), indication for transplantation, current immunosuppressive drug(s) median, minimum and maximumcontinuous were reported. other standard hand, both the count treatment, etc. For summarising data,On thethemean, deviation, and percentages were reported for discrete data. Invariably, there are situations where median, minimum and maximum were reported. On the other hand, both the count there is missingwere data.reported For purposes of analysis, subjects with missing continuous data and percentages for discrete data. Invariably, there are situations where had their values imputed by using the mean from measures of other records. For there is missing data. For purposes of analysis, subjects with missing continuous data discrete data, analysis was confined to available data and no imputation was done. had their values imputed by using the mean from measures of other records. For discrete data, analysis was confined to available data and no imputation was done. 3. Transplant Activity tables Activity provided the information on transplant activity, such as the time of 3. These Transplant transplant, of transplant, duration of etc. activity, such as the time of These tablestype provided the information onsurgery transplant transplant, type of transplant, duration of surgery etc. 4. Outcome outcome of a transplant activity was tabulated in this section. Kaplan Meier 4. The Outcome method was used estimate the probability of survival different durations. The outcome of a to transplant activity was tabulated in at this section. Kaplan Meier method was used to estimate the probability of survival at different durations. Time trend analysis was used to assess the association between time (e.g. year) and response (e.g.used outcome). Statistical tests such as Spearman correlation test Time trend variables analysis was to assess the association between time (e.g. year) and and chi-square test may be used to test whether or not the linear trend is statistically response variables (e.g. outcome). Statistical tests such as Spearman correlation test significant. this was notwhether performed as the is in isitsstatistically fifth year of and chi-squareUnfortunately, test may be used to test or not the registry linear trend operation. As more data is accrued to its database over time, time trend analysis will significant. Unfortunately, this was not performed as the registry is in its fifth year of be of interest in future. operation. As more data is accrued to its database over time, time trend analysis will be of interest in future.

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APPENDIX C APPENDIX C

APPENDIX C APPENDIX C GLOSSARY GLOSSARY AIIRB ACE AIIRB ADPKD ACE AG ADPKD ALL AG ALP ALL ALT ALP AML ALT Apr AML ASH Apr ATG ASH Aug ATG AVM Aug AZA AVM BMI AZA BMT BMI BP BMT BD BP BID BD CAPD BID CD CAPD CDA CD CF CDA CHD CF CKD CHD CMV CKD CRF CMV Dec CRF DF Dec DFS DF FD DFS Feb FD FK506 Feb GCT FK506 GFR GCT GMC GFR GS GMC GVHD GS HA GVHD Hb HA HbsAg Hb HCV HbsAg HD HCV HDL HD HDL

Angiotensin II Receptor Blocker AngiotensinIIConverting Enzyme Angiotensin Receptor Blocker Autosomal Dominant Polycystic Angiotensin Converting Enzyme Kidney Disease Antigen Dominant Polycystic Kidney Disease Autosomal Acute Lymphocytic Leukaemia Antigen Alkaline Phosphatase Acute Lymphocytic Leukaemia Alanine Transferase Alkaline Phosphatase Acute Myelogenous Alanine Transferase Leukaemia April Myelogenous Leukaemia Acute Ampang Puteri Specialist Hospital April Anti-thymocyte globulin Hospital Ampang Puteri Specialist August Anti-thymocyte globulin Arterio-venous Malformation August Azathioprine Malformation Arterio-venous Body Mass Index Azathioprine BloodMass and Marrow Body Index Transplantation Blood Pressure Blood and Marrow Transplantation Brain Pressure Death Blood brought in dead Brain Death Continuous Ambulatory Peritoneal Dialysis brought in dead Cardiac Death Continuous Ambulatory Peritoneal Dialysis Congenital Dyserythropoeitic Anaemia Cardiac Death Counting Fingers Congenital Dyserythropoeitic Anaemia Coronary Heart Counting FingersDisease Chronic Kidney Disease Coronary Heart Disease Cytomegalovirus Chronic Kidney Disease Case Report Form Cytomegalovirus December Case Report Form Deep Frozen December Disease-free Deep Frozen Survival Freeze DriedSurvival Disease-free February Freeze Dried Tacrolimus February Germ Cell Tumour Tacrolimus Glomerular Filtration Rate Germ Cell Tumour Gleneagles Medical Glomerular FiltrationCentre Rate GentamicinMedical and Streptomycin Gleneagles Centre Graft Versusand Host Disease Gentamicin Streptomycin Hospital Ampang Graft Versus Host Disease Haemoglobin Hospital Ampang Hepatitis B surface Antigen Haemoglobin HepatitisBCsurface Virus Antigen Hepatitis Haemodialysis Hepatitis C Virus High Density Lipoprotein Haemodialysis High Density Lipoprotein 185 185

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APPENDIX C APPENDIX C

National Transplant Registry 2008

HKL HLA HLT HM HPP HSCT HUKM HUSM ICT ICU IHD IJN IL2R IOL Jan JNC Jul Jun KLA KLP LDL LQ LWE Mar Max MDS Min MK mm MMF MOH Nov MVA NCEP NET NPL NTPMU NTR Oct Paed PBSC PJ PK PL pmp QoL RMS SD

Hospital Kuala Lumpur Human Leukocyte Antigen APPENDIX C Heart Lung Transplant Hand Movement GLOSSARY Hospital Pulau Pinang Haematopoietic Stem Cell Transplantation AIIRB Hospital Universiti Kebangsaan Malaysia ACE Hospital Universiti Sains Malaysia ADPKD Information and Communication Technology AG Intensive Care Unit ALL Ischaemic Heart Disease ALP Institut Jantung Negara ALT Interleukin 2 Receptor AML Intraocular Lens Apr January ASH Joint National Committee ATG July Aug June AVM HKL, Adult AZA HKL, Paediatric BMI Low Density Lipoprotein BMT Lower Quartile BP Lam Wah Ee Hospital BD March BID Maximum CAPD Myelodysplastic Syndrome CD Minimum CDA McCarey and Kaufman CF millimetres CHD Mycophenolate Mofetil CKD Ministry of Health, Malaysia CMV November CRF Motor Vehicle Accident Dec National Cholesterol Education Program DF Neuroectodermal Tumour DFS No Perception of Light FD National Transplant Procurement and Management Unit Feb National Transplant Registry FK506 October GCT Paediatric GFR Peripheral Blood Stem Cells GMC Petaling Jaya GS Penetrating Keratoplastry GVHD Perception of Light HA per million population Hb Quality of Life HbsAg Rhabdomyosarcoma HCV Standard Deviation HD HDL 186

Angiotensin Angiotensin Autosomal D Antigen Acute Lymph Alkaline Pho Alanine Tran Acute Myelo April Ampang Pute Anti-thymocy August Arterio-veno Azathioprine Body Mass I Blood and M Blood Pressu Brain Death brought in de Continuous A Cardiac Deat Congenital D Counting Fin Coronary He Chronic Kidn Cytomegalov Case Report December Deep Frozen Disease-free Freeze Dried February Tacrolimus Germ Cell Tu Glomerular F Gleneagles M Gentamicin a Graft Versus Hospital Am Haemoglobin Hepatitis B s Hepatitis C V Haemodialys High Density

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APPENDIX C APPENDIX C

SDP Sept APPENDIX C SJA GLOSSARY SJP SOP AIIRB SQL ACE UKM ADPKD UMA AG UMMC ALL UMP ALP UQ ALT USA AML USM Apr VA ASH VOD ATG WP Aug AVM AZA BMI BMT BP BD BID CAPD CD CDA CF CHD CKD CMV CRF Dec DF DFS FD Feb FK506 GCT GFR GMC GS GVHD HA Hb HbsAg HCV HD HDL

Source Data Provider September Sime Darby Medical Centre, Subang Jaya (Adult) Sime Darby Medical Centre, Subang Jaya (Paediatric) Standard Operating Procedure Angiotensin II Receptor Blocker Structured Query Language Angiotensin ConvertingMalaysia Enzyme Universiti Kebangsaan Autosomal Dominant Polycystic Kidney Disease UMMC, Adult Antigen Malaya Medical Centre University Acute Lymphocytic UMMC, Paediatric Leukaemia Alkaline Phosphatase Upper Quartile AlanineStates Transferase United of America Acute Myelogenous Leukaemia Universiti Sains Malaysia April Acuity Visual Ampang Puteri Specialist Veno-Occlusive Disease Hospital Anti-thymocyte globulin Wilayah Persekutuan (Federal Territory) August Arterio-venous Malformation Azathioprine Body Mass Index Blood and Marrow Transplantation Blood Pressure Brain Death brought in dead Continuous Ambulatory Peritoneal Dialysis Cardiac Death Congenital Dyserythropoeitic Anaemia Counting Fingers Coronary Heart Disease Chronic Kidney Disease Cytomegalovirus Case Report Form December Deep Frozen Disease-free Survival Freeze Dried February Tacrolimus Germ Cell Tumour Glomerular Filtration Rate Gleneagles Medical Centre Gentamicin and Streptomycin Graft Versus Host Disease Hospital Ampang Haemoglobin Hepatitis B surface Antigen Hepatitis C Virus Haemodialysis High Density Lipoprotein 187 185

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APPENDIX D APPENDIX C

National Transplant Registry 2008

APPENDIX D DIRECTORY OF PARTICIPATING CENTRES Blood and Marrow Transplant Services

APPENDIX C GLOSSARY

AIIRB ACE ADPKD MOH AG ALL Hospital Ampang Hospital Kuala Lumpur ALP Jalan Mewah Utara Paediatrics BMT Unit ALT Pandan Mewah Institute Paediatrics AML 68000 Ampang Jalan Pahang Apr Kuala Lumpur 50586 Kuala Lumpur ASH Tel : ( 03)42896000 Ext : 6381 Tel : ( 03)26155555 Ext : 6905 ATG Fax : ( 03)42970059 Fax : ( 03)26948187 Aug AVM AZA BMI BMT PRIVATE BP BD Ampang Puteri Specialist Hospital Gleneagles Medical Centre, Penang BID 1 Jalan Mamanda 9 Oncology-Haematology Department CAPD 68000 Ampang 1, Jalan Pangkor CD Selangor Darul Ehsan 10050 Penang CDA Tel : ( 03)42702500 Ext : 4478 Tel : ( 04)2202189 CF Fax : ( 03)42702938 Fax : ( 04)2262994 CHD CKD CMV Lam Wah Ee Hospital Sime Darby Medical Centre Subang CRF Jaya Oncology-Haematology Department Haematology Department Dec Jalan Tan Sri Teh Ewe Lim 1, Jalan SS 12/1A DF 11600 Penang 47500 Subang Jaya DFS Tel : ( 04)6528836 Selangor Darul Ehsan FD Fax : ( 04)6570940 Tel : ( 03)56391212 Feb Fax : ( 03)56391209 FK506 GCT Sime Darby Medical Centre Subang Jaya GFR Paediatrics BMT Unit GMC 1, Jalan SS 12/1A GS 47500 Subang Jaya GVHD Selangor Darul Ehsan HA Tel : ( 03)56306361 Hb Fax : ( 03)56306209 HbsAg HCV HD HDL 188

Angiotensin I Angiotensin C Autosomal D Antigen Acute Lymph Alkaline Pho Alanine Tran Acute Myelo April Ampang Pute Anti-thymocy August Arterio-venou Azathioprine Body Mass In Blood and M Blood Pressu Brain Death brought in de Continuous A Cardiac Deat Congenital D Counting Fin Coronary Hea Chronic Kidn Cytomegalov Case Report F December Deep Frozen Disease-free Freeze Dried February Tacrolimus Germ Cell Tu Glomerular F Gleneagles M Gentamicin a Graft Versus Hospital Amp Haemoglobin Hepatitis B su Hepatitis C V Haemodialys High Density

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APPENDIX D APPENDIX C

Blood and Marrow Transplant Services APPENDIX C UNIVERSITY GLOSSARY AIIRB Angiotensin II Receptor Blocker Hospital UniversitiAngiotensin KebangsaanConverting Enzyme ACE Hospital Universiti Sains Malaysia Malaysia ADPKD Autosomal Dominant Polycystic KidneyStem Disease Haemapoietic Cell Transplant Maybank BMT Centre AG Antigen Unit Jalan Yaacob LatifAcute Lymphocytic Leukaemia ALL Jalan Sultanah Zainab II Bandar Tun Razak,Alkaline Cheras Phosphatase 16150 Kota Bharu ALP 56000 Kuala lumpur Kelantan Darul Naim ALT Alanine Transferase Tel : ( 03)91455555 : 6336 Tel : ( 09) 7663349 AML AcuteExt Myelogenous Leukaemia Fax : ( 03)91738255 Apr April ASH Ampang Puteri Specialist Hospital ATG Anti-thymocyte globulin Aug August University of Malaya Medical Centre University of Malaya Medical Centre AVM Arterio-venous Malformation Division of Haematology Paediatric BMT Unit AZA Azathioprine Department of Medicine Department of Paediatrics BMI Body Mass Index Jalan Universiti Jalan Universiti BMT Blood and Marrow Transplantation 59100 Kuala Lumpur 59100 Kuala Lumpur BP Blood Pressure Tel : ( 03)79492741 Tel : ( 03)79492065 BD Brain Death Fax : ( 03)79557740 Fax : ( 03)79556114 BID brought in dead CAPD Continuous Ambulatory Peritoneal Dialysis CD Cardiac Death CDA Congenital Dyserythropoeitic Anaemia CF Counting Fingers CHD Coronary Heart Disease CKD Chronic Kidney Disease CMV Cytomegalovirus CRF Case Report Form Dec December DF Deep Frozen DFS Disease-free Survival FD Freeze Dried Feb February FK506 Tacrolimus GCT Germ Cell Tumour GFR Glomerular Filtration Rate GMC Gleneagles Medical Centre GS Gentamicin and Streptomycin GVHD Graft Versus Host Disease HA Hospital Ampang Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 189 185

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APPENDIX D APPENDIX C

National Transplant Registry 2008

Bone and Tissue Transplant Services

APPENDIX C GLOSSARY

MOH Hospital Ipoh Department of Orthopaedics Jalan Hospital 30990 Ipoh Perak Darul Ridzuan Tel : ( 05)5222460 Fax : ( 05)2412826 Hospital Kangar Jabatan Ortopedik & Traumatologi Jalan Kolam 01000 Kangar Perlis Indera Kayangan Tel : ( 04)9763333 Ext : 1184 Fax : ( 04)9767237 Hospital Kuala Lumpur Ophthalmology Department Jalan Pahang 50586 Kuala Lumpur Tel : ( 03)26155555 Ext : 6801 Fax : ( 03)26925276

Hospital Pakar Sultanah Fatimah Orthopaedics Department Jalan Salleh 84000 Muar Johor Darul Takzim Tel : ( 06)9521901 Hospital Raja Perempuan Zainab II Department of Surgery Jalan Hospital 15590 Kota Bharu Kelantan Darul Naim Tel : ( 09)7452000 Ext : 2013/2237 Fax : ( 09) 7475418

AIIRB ACE Hospital Kajang Orthopaedics Department ADPKD Jalan Semenyih AG 43000 Kajang ALL Selangor Darul Ehsan ALP Tel : ( 03)87363333 ALT AML Apr Hospital Kuala Lumpur ASH Institute of Orthopaedic & ATG Traumatology Aug Jalan Pahang AVM 50586 Kuala Lumpur AZA Tel : ( 03)26155555 Ext : 5543/5534 BMI Fax : ( 03)26927281 BMT BP Hospital Kuantan BD Department of Orthopaedics BID Jalan Tanah Puteh CAPD 25100 Kuantan CD Pahang Darul Makmur CDA Tel : ( 09)5133333 Ext : 2903 CF Fax : ( 09)5142712 CHD CKD Hospital Pulau Pinang CMV Department of Orthopaedics CRF Jalan Residensi Dec 10990 Pulau Pinang DF Tel : ( 04)2225127 DFS Fax : ( 04)2226127 FD Feb FK506 Hospital Raja Perempuan Zainab II Department of Orthopaedics GCT GFR Jalan Hospital GMC 15590 Kota Bharu GS Kelantan Darul Naim GVHD Tel : ( 09)7485533 Ext : 2374/2364 HA Fax : ( 09)7486951 Hb HbsAg HCV HD HDL 190

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APPENDIX D APPENDIX C

Bone and Tissue Transplant Services APPENDIX C MOH GLOSSARY AIIRB II Receptor Blocker Hospital SeberangAngiotensin Jaya Hospital Sultanah Aminah ACE Angiotensin Converting Enzyme Orthopaedics Department Orthopaedics Department ADPKD Autosomal Dominant Polycystic Kidney Disease Bandar Baru 80100 Johor Bahru AG Antigen 13700 Seberang Jaya Johor Darul Takzim ALL Acute Lymphocytic Leukaemia Pulau Pinang Tel : ( 07)2231666 ALP Alkaline Phosphatase Tel : ( 04)3983333 ALT Alanine Transferase AML Myelogenous Leukaemia Hospital SultanahAcute Bahiyah Hospital Sultanah Bahiyah Apr April Ophthalmology Department Department of Orthopaedic Surgery ASH Hospital 06550 Alor Setar Ampang Puteri Specialist06550 Alor Setar ATG Anti-thymocyte globulin Kedah Darul Aman Kedah Darul Aman Aug Tel : ( 04)7002248August Tel : ( 04)7303333 Ext : 179 AVM Arterio-venous Malformation Fax : ( 04)7323770 Fax : ( 04)7323770 AZA Azathioprine BMI Mass Index Hospital Sultanah Body Nur Zahirah Hospital Sungai Buloh BMT Blood and Marrow Transplantation Orthopaedic Department Ophthalmology Department BP Blood Pressure Jalan Sultan Mahmud 47000 Sungai Buloh BD Brain Death 20400 Kuala Terengganu Selangor Darul Ehsan BID Terengganu Darulbrought Iman in dead Tel : ( 03)61561324 CAPD Continuous Ambulatory Peritoneal Dialysis Tel : ( 09)6212121 CD Cardiac Death CDA Congenital Dyserythropoeitic Anaemia Hospital Teluk Intan Hospital Taiping Counting Fingers CF Department of Orthopaedic CHD Coronary Surgery Heart Disease Ophthalmology Department Jalan Taming SariChronic Kidney Disease Jalan Changkat Jong CKD 36000 Teluk Intan 34000 Taiping Cytomegalovirus CMV Perak Darul Ridzuan Perak Darul Ridzuan CRF Case Report Form Tel :( 05)6213333 Ext : 1330 Tel : ( 05)8408037 Dec December Fax : ( 05)6237343 Fax : ( 05)8073894Deep Frozen DF DFS Disease-free Survival FD Freeze Dried Hospital Tengku Ampuan Afzan Hospital Tengku Ampuan Rahimah Feb February Ophthalmology Department Ophthalmology Department 25100 Kuantan Tacrolimus 41200 Klang FK506 Pahang Darul Makmur Selangor Darul Ehsan GCT Germ Cell Tumour Tel : ( 03)33723333 Ext : 1336 Tel : ( 09)5133333 Ext : 2454 GFR Glomerular Filtration Rate Fax : ( 03)33729089 Fax : ( 09)5142712Gleneagles Medical Centre GMC GS Gentamicin and Streptomycin GVHD Graft Versus Host Disease HA Hospital Ampang Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 191 185

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APPENDIX D APPENDIX C

Fifth Report of the National Transplant Registry 2008

Bone and Tissue Transplant Services

APPENDIX C

MOH Hospital Tengku Ampuan Rahimah Orthopaedic Clinic 41200 Klang Selangor Darul Ehsan Tel : ( 03)33723333 Ext : 1225 Fax : ( 03)33729089 PRIVATE Hospital Fatimah 1, Jalan Chew Peng Loon Ipoh Garden 31400 Ipoh Perak Darul Ridzuan Tel : ( 05)5455777 Fax : ( 05)5477050 Kota Bharu Medical Centre Lot 179-184, Section 24 Jalan Sultan Yahya Petra 15200 Lundang, Kota Bharu Kelantan Darul Naim Tel : ( 09)7433399 Fax : ( 09)7433800 Seremban Specialist Hospital Wan Orthopaedic, Trauma & Sports Injury Centre (WOTSIC) Suite 17, Seremban Specialist Hospital, Jalan Toman 1, Kemayan Square 70200 Seremban Negeri Sembilan Darul Khusus Tel : ( 06)7677800 Ext : 130 / 131 Fax : ( 06)7675900 Timberland Medical Centre Lorong 2, 2 1/2 miles Rock Road 93250 Kuching Sarawak Tel : (082)234466 Ext : 503 Fax : (082)232259

GLOSSARY AIIRB ACE ADPKD AG ALL ALP ALT AML Apr ASH ATG Island Hospital Aug 308, Macalister Road AVM 10450 Penang AZA Pulau Pinang BMI Tel : ( 04)2205527 BMT Fax : ( 04)2267989 BP BD BID Normah Medical Specialist Centre CAPD P.O Box 3298 CD 93764 Kuching Sarawak CDA Tel : (082)440055 CF Fax : (082)442600 CHD CKD CMV CRF Sri Kota Medical Centre Ophthalmology Department Dec DF Jalan Mohet DFS 41000 Klang FD Selangor Darul Ehsan Tel : ( 03)33733636 Feb Fax : ( 03)33736888 FK506 GCT GFR GMC GS GVHD HA Hb HbsAg HCV HD HDL Hospital Umum Sarawak Orthopaedic Department 93586 Kuching Sarawak Tel : (082)276433 Fax : (082)419495

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Bone and Tissue Transplant Services APPENDIX C UNIVERSITY GLOSSARY AIIRB Angiotensin II Receptor Blocker Hospital Universiti Sains Malaysia Hospital Universiti Sains Malaysia ACE Angiotensin Converting Enzyme Ophthalmology Department Orthopaedics Department ADPKD Autosomal Dominant Polycystic Kidney Disease 16150 Kubang Kerian 16150 Kota Bharu AG Antigen Kelantan Darul Naim Kelantan Darul Naim ALL Acute Lymphocytic Leukaemia Tel : ( 09)7664370 Tel : ( 09) 7664509 ALP Fax : (09)7653370Alkaline Phosphatase Fax : ( 09) 7653370 ALT Alanine Transferase AML Acute Myelogenous Leukaemia Apr April International Islamic University University of Malaya Medical Centre ASH Ampang Puteri SpecialistDepartment Hospital of Orthopaedics Surgery Malaysia ATG Anti-thymocyte globulin Jalan Universiti Department of Orthopaedics, Aug Traumatology andAugust Rehabilitation 59100 Kuala Lumpur AVM Arterio-venous Malformation Kulliyah of Medicine Tel : ( 03)79492061 AZA Azathioprine Jalan Hospital Fax : ( 03)79535642 BMI 25100 Kuantan Body Mass Index BMT Blood and Marrow Transplantation Pahang Darul Makmur Tel : ( 09)5132797Blood Pressure BP Fax : ( 09)5151518Brain Death BD BID brought in dead TISSUE BANKContinuous Ambulatory Peritoneal Dialysis CAPD CD Cardiac Death CDA Congenital Dyserythropoeitic Anaemia National Tissue Bank CF Counting Fingers Universiti Sains Malaysia CHD Health Campus Coronary Heart Disease CKD 16150 Kota BharuChronic Kidney Disease Kelantan Darul Naim CMV Cytomegalovirus Tel : ( 09)7664344Case Report Form CRF Fax : ( 09)7653307December Dec DF Deep Frozen DFS Disease-free Survival FD Freeze Dried Feb February FK506 Tacrolimus GCT Germ Cell Tumour GFR Glomerular Filtration Rate GMC Gleneagles Medical Centre GS Gentamicin and Streptomycin GVHD Graft Versus Host Disease HA Hospital Ampang Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 193 185

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APPENDIX D APPENDIX C

Fifth Report of the National Transplant Registry 2008

Bone and Tissue Transplant Services

APPENDIX C

BONE BANK Bone Bank, Hospital Kuala Lumpur Institute of Orthopaedic & Traumatology Jalan Pahang 50586 Kuala Lumpur Tel : ( 03)26155555 Ext : 5543/5534 Fax : ( 03)26927281

IRRADIATION CENTRE Malaysian Nuclear Agency Research Tissue Bank Nuclear Agensi Malaysia Bangi 43000 Kajang Selangor Darul Ehsan Tel : ( 03) 89250510 Ext : 1611 Fax : ( 03) 89282956

GLOSSARY AIIRB Bone Bank, University of Malaya ACE Medical Centre ADPKD Department of Orthopaedics Surgery AG Jalan Universiti ALL 59100 Kuala Lumpur ALP Tel : ( 03)79492061 ALT Fax : ( 03)79535642 AML Apr ASH ATG Aug AVM AZA BMI BMT BP BD BID CAPD CD CDA CF CHD CKD CMV CRF Dec DF DFS FD Feb FK506 GCT GFR GMC GS GVHD HA Hb HbsAg HCV HD HDL 194

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APPENDIX D APPENDIX C

Cornea Transplant Services APPENDIX C MOH GLOSSARY AIIRB Angiotensin II Receptor Blocker Hospital Batu Pahat Hospital Bukit Mertajam ACE Angiotensin Converting Enzyme Ophthalmology Department Ophthalmology Department ADPKD Autosomal Dominant Polycystic Kidney Disease 83000 Batu Pahat Jalan Kulim AG Antigen Johor Darul Takzim 14000 Bukit Mertajam ALL Acute Lymphocytic Leukaemia Tel : ( 07)4341999 Pulau Pinang ALP Fax : ( 07)4322544Alkaline Phosphatase Tel : ( 04)5383333 Ext : 256 / 259 ALT Alanine Transferase Fax : ( 04)5388435 AML Acute Myelogenous Leukaemia Apr April Hospital Duchess of Kent Hospital Ipoh ASH Ampang Puteri Specialist Hospital Ophthalmology Department Ophthalmology Department ATG Anti-thymocyte globulin Jalan Hospital KM 3.2 Jalan Utara Aug 90000 Sandakan August 30990 Ipoh AVM Arterio-venous Malformation Sabah Perak Darul Ridzuan Tel : (089)212111 Azathioprine Tel : ( 05)5222034 AZA Fax : (089)213607Body Mass Index Fax : ( 05)2531541 BMI BMT Blood and Marrow Transplantation BP Blood Pressure Hospital Kangar Hospital Kuala Lipis BD Brain Death Ophthalmology Department Ophthalmology Department BID brought in dead Jalan Kolam 27200 Kuala Lipis CAPD Continuous Ambulatory Peritoneal Dialysis 01000 Kangar Pahang Darul Makmur CD Cardiac Death Perlis Indera Kayangan Tel : ( 09)3123333 Ext : 114 CDA Dyserythropoeitic Tel : ( 04)9763333Congenital Ext : 2031 Fax : Anaemia ( 09)3121787 CF Fax : ( 04)9767237Counting Fingers CHD Coronary Heart Disease CKD Chronic Kidney Disease Hospital Kuala Pilah Hospital Kuala Lumpur CMV Cytomegalovirus Ophthalmology Department Ophthalmology Department CRF Case Report Form 72000 Kuala Pilah Jalan Pahang Dec December Negeri Sembilan Darul Khusus 50586 Kuala Lumpur DF Deep Frozen Tel : ( 06)4818001 Ext : 170 / 175 Tel : ( 03)26155555 Ext : 6801 DFS Disease-free Survival Fax : ( 06)4818010 Fax : ( 03)26925276 FD Freeze Dried Feb February FK506 Hospital Mentakab Hospital Melaka Tacrolimus GCT Germ Cell Tumour Ophthalmology Department Ophthalmology Department GFR Glomerular Filtration Rate Jalan Maran Jalan Mufti Haji Khalil GMC Gleneagles Medical Centre 28900 Temerloh 75400 Melaka GS Gentamicin and Streptomycin Pahang Darul Makmur Melaka GVHD Tel : ( 09)2955333 Ext : 1570 Tel : ( 06)2707215Graft Versus Host Disease HA Hospital Ampang Fax : ( 06)2818488 Fax : ( 09)2972468 Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 195 185

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APPENDIX D APPENDIX C

Fifth Report of the National Transplant Registry 2008

Cornea Transplant Services

APPENDIX C

MOH

Hospital Miri Ophthalmology Department Jalan Cahaya 98000 Miri Sarawak Tel : (085)420033 Ext : 148 Fax : (085)416514 Hospital Pulau Pinang Eye Clinic Jalan Residensi 10990 Georgetown Pulau Pinang Tel : ( 04)2002283 Fax : ( 04)2281737 Hospital Queen Elizabeth Ophthalmology Department 88586 Kota Kinabalu Sabah Tel : (088)206153 Fax : (088)252827

Hospital Selayang Ophthalmology Department Lebuhraya Selayang-Kepong Batu Caves 68100 Bandar Baru Selayang Selangor Darul Ehsan Tel : ( 03)61367788 Ext : 4069/3254 Fax : ( 03)61207564 Hospital Sultan Ismail Ophthalmology Department Jalan Persiaran Mutiara Emas Utama 81100 Johor Bahru Johor Darul Takzim Tel : ( 07)3565000 Fax : ( 07)3565034

GLOSSARY AIIRB ACE Hospital Pakar Sultanah Fatimah Ophthalmology Department ADPKD AG Jalan Salleh ALL 84000 Muar ALP Johor Darul Takzim ALT Tel : ( 07)9521901 Ext : 147 / 227 AML Apr Hospital Putrajaya Ophthalmology Department ASH Pusat Pentadbiran Kerajaan ATG Aug Persekutuan Presint 7 AVM 62250 Putra Jaya AZA Selangor Darul Ehsan BMI Tel : ( 03)83124200 Ext : 4231/4279 BMT Fax : ( 03)88880137 BP Hospital Raja Perempuan Zainab BD II Ophthalmology Department BID Jalan Hospital CAPD 15586 Kota Bharu CD Kelantan Darul Naim CDA Tel : ( 09)7485533 Ext : 2254 CF Fax : ( 09)7502236 CHD CKD CMV Hospital Sibu Ophthalmology Department CRF Batu 5 1/2 Jalan Ulu Oya Dec 96000 Sibu DF Sarawak DFS Tel : (084)343333 Ext : 1008/1009 FD Fax : (084)337354 Feb FK506 GCT Hospital Sultanah Aminah GFR Ophthalmology Department GMC 80100 Johor Bahru GS Johor Darul Takzim GVHD Tel : ( 07)2231666 Ext : 2690 HA Fax : ( 07)2242694 Hb HbsAg HCV HD HDL 196

Fifth Report of the National Transplant Registry 2008 Fifth Report of the Fifth Report of the National Transplant Registry 2008 National Transplant Registry 2008

APPENDIX D APPENDIX C

Cornea Transplant Services APPENDIX C MOH GLOSSARY AIIRB II Receptor Blocker Hospital Sultanah Angiotensin Bahiyah Hospital Sultanah Nur Zahirah ACE Angiotensin Converting Enzyme Ophthalmology Department Ophthalmology Department ADPKD Kidney Disease 05460 Alor Setar Autosomal Dominant Polycystic Jalan Sultan Mahmud AG Antigen Kedah Darul Aman 20400 Kuala Terengganu ALL Tel : ( 04)7407873Acute Lymphocytic Leukaemia Terengganu Darul Iman ALP Alkaline Phosphatase Fax : ( 04)7406154 Tel : ( 09)6212121 Ext : 2727/2024 ALT Alanine Transferase Fax : ( 09)6317871 AML Acute Myelogenous Leukaemia Apr April Hospital Sungai Buloh Hospital Sungai Petani ASH Ampang Puteri Specialist Hospital Ophthalmology Department Ophthalmology Department ATG Anti-thymocyte globulin 08000 Sungai Petani Jalan Hospital Aug August 47000 Sungai Buloh Kedah Darul Aman AVM Arterio-venous Malformation Selangor Darul Ehsan Tel : ( 04)4213333 Ext : 127 Tel : ( 03)61561324 Fax : ( 04)4212403 AZA Azathioprine Fax : ( 03)61562470 BMI Body Mass Index BMT Blood and Marrow Transplantation BP Blood Pressure Hospital Taiping Hospital Tawau BD Brain Death Ophthalmology Department Ophthalmology Department BID Jalan Taming Sari brought in dead P.O. Box 67 CAPD Continuous Ambulatory Peritoneal Dialysis 34000 Taiping 91007 Tawau CD Cardiac Death Perak Darul Ridzuan Sabah CDA Dyserythropoeitic Tel : ( 05)8083333Congenital Ext : 8050/8053 Tel : Anaemia (089)773533 Ext : 179 Fax : ( 05)8073894Counting Fingers Fax : (089)768626 CF CHD Coronary Heart Disease CKD Chronic Kidney Disease Hospital Tengku Ampuan Afzan Hospital Teluk Intan CMV Cytomegalovirus Ophthalmology Department Ophthalmology Department CRF Case Report Form 25100 Kuantan Jalan Changkat Jong Dec 36000 Teluk IntanDecember Pahang Darul Makmur DF Deep Frozen Perak Darul Ridzuan Tel : ( 09)5133333 Ext : 2454 DFS Tel : ( 05)6213333Disease-free Ext : 1330Survival Fax : ( 09)5142712 FD Fax : ( 05)6237343Freeze Dried Feb February FK506 Tacrolimus Hospital Tuanku Ja'afar Hospital Tengku Ampuan Rahimah GCT Germ Cell Tumour Ophthalmology Department Ophthalmology Department GFR Glomerular Filtration Rate Jalan Langat Jalan Rasah GMC Gleneagles Medical Centre 41200 Klang 70300 Seremban GS Gentamicin and Streptomycin Negeri Sembilan Darul Khusus Selangor Darul Ehsan GVHD GraftExt Versus Host Disease Tel : ( 06)7623333 Ext : 5120 Tel : ( 03)33723333 : 1336/1338 HA Hospital Ampang Fax : ( 06)7625771 Fax : ( 03)33729089 Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 197 185

Fifth Report of the National Transplant Registry 2008

APPENDIX D APPENDIX C

Fifth Report of the National Transplant Registry 2008

Cornea Transplant Services

APPENDIX C

MOH Hospital Umum Sarawak Opthalmology Department Jalan Tun Ahmad Zaidi Adruce 93586 Kuching Sarawak Tel : (082)276513 Fax : (082)419495 ARMED FORCES 94 Hospital Angkatan Tentera Kem Terendak Ophthalmology Department 76200 Melaka Melaka Tel : ( 06)3573201 Ext : 1134/1127 Fax : ( 06)3572108 PRIVATE International Specialist Eye Centre Level 8, Centrepoint South, The Boulevard, Midvalley City Lingkaran Syed Putra 59200 Kuala Lumpur Tel : ( 03)22848989 Fax : ( 03)22844330

Gleneagles Medical Centre Ophthalmology Department Pulau Pinang Clinic Sdn Bhd 1, Jalan Pangkor 10050 Pulau Pinang Tel : ( 04)2202147 Fax : ( 04)2272498

GLOSSARY AIIRB ACE ADPKD AG ALL ALP ALT AML Apr ASH ATG Aug AVM AZA BMI BMT BP BD BID CAPD CD CDA CF CHD Gleneagles Intan Medical Centre Hope Eye Centre CKD Suite 618 CMV 282, Jalan Ampang CRF 50450 Kuala Lumpur Dec Tel : ( 03)42578112 DF Fax : ( 03)42576112 DFS FD Feb FK506 Hospital Pantai Indah Ophthalmology Department GCT GFR Jalan Perubatan 1 GMC Pandan Indah GS 55100 Kuala Lumpur Tel : ( 03)42892947 GVHD HA Hb HbsAg HCV HD HDL 198

Fifth Report of the National Transplant Registry 2008 Fifth Report of the Fifth Report of the National Transplant Registry 2008 National Transplant Registry 2008

APPENDIX D APPENDIX C

Cornea Transplant Services APPENDIX C PRIVATE GLOSSARY AIIRB Angiotensin K. C. Yeo Eye Specialist CentreII Receptor Blocker Mahkota Medical Centre ACE Converting Enzyme No. 309-310, JalanAngiotensin Melaka Raya 1 Suite 101, 1st Floor, ADPKD Kidney Disease Tmn Melaka RayaAutosomal Dominant Polycystic 3, Mahkota Melaka, Jalan Merdeka AG Antigen 75000 Melaka 75000 Melaka ALL Tel : ( 06)2833510Acute Lymphocytic Leukaemia Tel : ( 06)2818222 ALP Alkaline Phosphatase ALT Alanine Transferase AML Acute Myelogenous Leukaemia Apr April For Sight Pusat Pakar Mata Centre Puteri Specialist Hospital, JB ASH Ampang Puteri Specialist Hospital 1-1, Jalan SS23/15, 33, Jalan Tun Abdul Razak (Susur 5) ATG Anti-thymocyte globulin 80350 Johor Bahru Taman SEA Aug August 47400 Petaling Jaya Johor Darul Takzim AVM Arterio-venous Malformation Selangor Darul Ehsan ( 07)2233377 AZA Azathioprine Tel : ( 03)78044051 ( 07)2238833 BMI Body Mass Index BMT Blood and Marrow Transplantation BP Blood Sri Kota Medical Centre Pressure Sunway Medical Centre BD Brain Death Ophthalmology Department No 5, Jln Lagoon Selatan BID brought in dead Jalan Mohet Bandar Sunway CAPD Continuous Ambulatory Peritoneal Dialysis 41000 Klang 46150 Petaling Jaya CD Cardiac Death Selangor Darul Ehsan Selangor Darul Ehsan CDA Congenital Dyserythropoeitic Tel : ( 03)33733636 Ext : 7206 Tel : Anaemia ( 03)74919191 Ext : 6612/6613 CF Counting Fingers Fax : ( 03)33736888 CHD Coronary Heart Disease CKD Tan Eye SpecialistChronic Centre Kidney Disease Tun Hussein Onn National Eye CMV Cytomegalovirus Hospital Sunway Medical Centre CRF Case Report Form Lorong Utara B No 5, Jln Lagoon Selatan Dec 46200 Petaling Jaya Bandar Sunway December DF Deep Frozen 46150 Petaling Jaya Selangor Darul Ehsan DFS Disease-free Survival Tel : ( 03)79561511 Selangor Darul Ehsan FD Freeze Fax : ( 03)79576128 Tel : ( 03)74919191 ExtDried : 1602 Feb February Fax : ( 03)79826025 FK506 Tacrolimus GCT Germ Cell Tumour GFR Glomerular Filtration Rate GMC Gleneagles Medical Centre GS Gentamicin and Streptomycin GVHD Graft Versus Host Disease HA Hospital Ampang Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 199 185

Fifth Report of the National Transplant Registry 2008

APPENDIX D APPENDIX C

Fifth Report of the National Transplant Registry 2008

Cornea Transplant Services

APPENDIX C

UNIVERSITY Hospital Universiti Kebangsaan Malaysia Ophthalmology Department Faculty of Medicine Jalan Yaacob Latif Bandar Tun Razak, Cheras 56000 Kuala lumpur Tel : ( 03)91702497 Fax : ( 03)91737836

University of Malaya Medical Centre Ophthalmology Department Faculty of Medicine 59100 Kuala Lumpur Tel : ( 03) 79502060 Fax : ( 03) 79535635

GLOSSARY AIIRB Hospital Universiti Sains Malaysia Ophthalmology Department ACE ADPKD 16150 Kubang Kerian AG Kelantan Darul Naim ALL Tel : ( 09)7664370 ALP Fax : ( 09)7653370 ALT AML Apr ASH ATG Aug AVM AZA BMI BMT BP BD BID CAPD CD CDA CF CHD CKD CMV CRF Dec DF DFS FD Feb FK506 GCT GFR GMC GS GVHD HA Hb HbsAg HCV HD HDL 200

Fifth Report of the National Transplant Registry 2008 Fifth Report of the Fifth Report of the National Transplant Registry 2008 National Transplant Registry 2008

APPENDIX D APPENDIX C

Heart and Lung Transplant Services APPENDIX C MOH GLOSSARY AIIRB Angiotensin II Receptor Blocker Hospital Kuala Lumpur Institute Jantung Negara ACE Institut Perubatan Angiotensin Respiratori Converting Enzyme Cardiothoracic Department ADPKD Autosomal Dominant Polycystic Kidney Disease Jalan Pahang 145, Jalan Tun Razak AG Antigen 50586 Kuala Lumpur 50400 Kuala Lumpur Tel : ( 03)40232966 Tel : ( 03)26178200 ALL Acute Lymphocytic Leukaemia Fax : ( 03)40218807 ALP Alkaline Phosphatase Fax : ( 03)26928418 ALT Alanine Transferase AML Acute Myelogenous Leukaemia Apr April ASH Ampang Puteri Specialist Hospital Heart Valve Transplant Services ATG Anti-thymocyte globulin Aug August MOH AVM Arterio-venous Malformation AZA Azathioprine BMI Body Institute Jantung NegaraMass Index BMT Blood and Marrow Transplantation Cardiovascular Tissue Bank BP Blood Pressure Department Of Cardiothoracic Surgery BD Brain Death 145, Jalan Tun Razak BID brought in dead 50400 Kuala Lumpur CAPD Continuous Ambulatory Peritoneal Dialysis Tel : ( 03)2617 8200 Fax : ( 03)2692 8418 CD Cardiac Death CDA Congenital Dyserythropoeitic Anaemia CF Counting Fingers CHD Coronary Heart Disease CKD Chronic Kidney Disease CMV Cytomegalovirus CRF Case Report Form Dec December DF Deep Frozen DFS Disease-free Survival FD Freeze Dried Feb February FK506 Tacrolimus GCT Germ Cell Tumour GFR Glomerular Filtration Rate GMC Gleneagles Medical Centre GS Gentamicin and Streptomycin GVHD Graft Versus Host Disease HA Hospital Ampang Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 201 185

Fifth Report of the National Transplant Registry 2008

APPENDIX D APPENDIX C

Fifth Report of the National Transplant Registry 2008

APPENDIX C

Kidney Transplant Services MOH Hospital Batu Pahat Renal Transplant Clinic c/o Haemodialysis Unit 83000 Batu Pahat Johor Darul Takzim Tel 1 : ( 07)4341999 Ext : 149 Tel 2 : ( 07)4340654 Fax : ( 07)4322544 Hospital Duchess of Kent Renal Transplant Clinic c/o Haemodialysis Unit KM3.2, Jalan Utara 90007 Sandakan Sabah Tel 1 : (089)212111 Ext : 5190 Tel 2 : (089)212739 Fax : (089)213607 Hospital Kemaman Renal Transplant Clinic c/o Haemodialysis Unit 24000 Kemaman Terengganu Darul Iman Tel : ( 09)8593333 Ext : 2012 Fax : ( 09)8595512 Hospital Kuala Lumpur (Paed Tx Unit) Nephrology Clinic (Renal Transplant) Department of Nephrology Jalan Pahang 50586 Kuala Lumpur Tel : ( 03)26921044 Ext : 6021 Fax : ( 03)26948187

GLOSSARY AIIRB ACE Hospital Bintulu ADPKD Renal Transplant Clinic AG c/o Haemodialysis Unit ALL Jalan Nyabau ALP 97000 Bintulu ALT Sarawak AML Tel 1 : (086)255899 Apr Tel 2 : (086)311416 ASH Fax : (086)255866 ATG Aug Hospital Dungun AVM Renal Transplant Clinic AZA c/o Haemodialysis Unit BMI 23000 Dungun BMT Terengganu Darul Iman BP Tel : ( 09)8483333 Ext : 261 BD Fax : ( 09)8484160 BID CAPD CD Hospital Kluang CDA Renal Transplant Clinic CF c/o Haemodialysis Unit CHD Jalan Hospital 88000 Kluang CKD Johor Darul Takzim CMV Tel 1 : ( 07)7723333 Ext : 266 CRF/ 313 Tel 2 : ( 07)7723334 Dec Fax : ( 07)7734498 DF DFS Hospital Kuala Lumpur FD Nephrology Clinic (Renal Transplant) Feb Department of Nephrology FK506 Jalan Pahang GCT 50586 Kuala Lumpur GFR Tel 1 : ( 03)26155555 Ext :GMC 5910 Tel 2 : ( 03)26157561 GS Fax : ( 03)26938953 GVHD HA Hb HbsAg HCV HD HDL 202

Fifth Report of the National Transplant Registry 2008 Fifth Report of the Fifth Report of the National Transplant Registry 2008 National Transplant Registry 2008

APPENDIX D APPENDIX C

Kidney Transplant Services APPENDIX C MOH GLOSSARY AIIRB Hospital Labuan Angiotensin II Receptor Blocker Hospital Likas ACE Angiotensin Converting Enzyme Renal Transplant Clinic Renal Transplant Clinic ADPKD Dominant Polycystic Kidney Disease c/o Haemodialysis Unit c/o HaemodialysisAutosomal Unit AG Antigen 87020 Labuan 88996 Kota Kinabalu ALL Acute Lymphocytic Leukaemia Sabah Sabah ALP Alkaline Phosphatase Tel 1 : (087)423919 Ext : 274 Tel : (088)522600 Ext : 723 / 714 ALT Alanine Transferase Fax : (088)438512 Tel 2 : (087)410761 AML Acute Myelogenous Leukaemia Fax : (087)423928 Apr April ASH HospitalMersing Hospital Melaka Ampang Puteri SpecialistHospital ATG Anti-thymocyte globulin Renal Transplant Clinic Renal Transplant Clinic Aug c/o HaemodialysisAugust Unit c/o Haemodialysis Unit AVM Arterio-venous Malformation Tingkat Bawah, Blok D Jalan Ismail AZA Azathioprine Jalan Pringgit 86800 Mersing BMI Body Mass Index 70060 Melaka Johor Darul Takzim BMT Blood and Marrow Transplantation Tel 1 : ( 06)2822344 Tel 1 : ( 07)7993333 Ext : 126 Tel 2 : ( 06)2707648 Tel 2 : ( 07)7991415 BP Blood Pressure Fax : ( 06)2837500Brain Death Fax : ( 07)7994200 BD BID brought in dead CAPD Continuous Ambulatory Peritoneal Dialysis Hospital Miri Hospital Pakar Sultanah Fatimah CD Cardiac Death Renal Transplant Clinic Renal Transplant Clinic CDA Dyserythropoeitic Anaemia c/o HaemodialysisCongenital Unit c/o Haemodialysis Unit CF Counting Fingers 98000 Miri 84000 Muar CHD Coronary Heart Disease Johor Darul Takzim Sarawak CKD Disease Tel : ( 06)9521901 Ext : 116 Tel : (085)420033Chronic Ext : Kidney 251 CMV Fax : (085)416514Cytomegalovirus Fax : ( 06)9526003 CRF Case Report Form Dec December Hospital Pontian Deep Frozen Hospital Pulau Pinang DF Renal Transplant Clinic DFS Disease-free Survival Renal Transplant Clinic c/o Haemodialysis Unit Dried c/o Haemodialysis Unit FD Freeze Jalan Alfagoff February Jalan Residensi Feb 82000 Pontian 10990 Georgetown FK506 Tacrolimus Johor Darul Takzim Pulau Pinang GCT Germ Cell Tumour Tel 1 : ( 07)6873333 Ext : 202 Tel GFR Glomerular Filtration Rate : ( 04)2225333 Ext : 397 Tel 2 : ( 07)6874533 Fax : ( 04)2281737 GMC Gleneagles Medical Centre Fax : ( 07)6874533 GS Gentamicin and Streptomycin GVHD Graft Versus Host Disease HA Hospital Ampang Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 203 185

Fifth Report of the National Transplant Registry 2008

APPENDIX D

Fifth Report of the National Transplant Registry 2008

APPENDIX C

Kidney Transplant Services

APPENDIX C GLOSSARY

MOH Hospital Queen Elizabeth Renal Transplant Clinic c/o CADP Unit 88586 Kota Kinabalu Sabah Tel : (088)218166 Ext : 284 Fax : (088)211999

Hospital Raja Permaisuri Bainun Nephrology Clinic Jalan Hospital 30990 Ipoh Perak Darul Ridzuan Tel : ( 05)5222372 Fax : ( 05)2531541 Hospital Selayang Renal Transplant Clinic c/o Ward 7B Lebuhraya Selayang-Kepong 68100 Batu Caves Selangor Darul Ehsan Tel 1 : ( 03)61203233 Ext : 7007/7011 Tel 2 : ( 03)61380409 Fax : ( 03)61377097 Hospital Sibu Renal Transplant Clinic c/o Haemodialysis Unit 96000 Sibu Sarawak Tel : (084)343333 Ext : 2102 Fax : (084)337354

AIIRB Hospital Raja Perempuan Zainab II ACE Renal Transplant Clinic ADPKD c/o Haemodialysis Unit AG 15590 Kota Bharu ALL Kelantan Darul Naim ALP Tel 1 : ( 09)7485533 ALT Tel 2 : (09)7502801 AML Fax : ( 09)7486951 Apr ASH Hospital Segamat ATG Renal Transplant Clinic Aug c/o Haemodialysis Unit AVM 83500 Segamat AZA Johor Darul Takzim BMI Tel 1 : ( 07)9433333 Ext : 147 BMT Tel 2 : ( 07)9433334 BP Fax : ( 07)9434641 BD Hospital Serdang BID Renal Transplant Clinic CAPD c/o Haemodialysis Unit CD Jalan Puchong CDA 43000 Kajang CF Selangor Darul Ehsan CHD Tel 1 : ( 03)89475555 Ext : 1256 CKD Tel 2 : ( 03)89475282 CMV Fax : ( 03)89455317 CRF Dec DF Hospital Sultan Haji Ahmad Shah Renal Transplant Clinic DFS c/o Haemodialysis Unit FD Jalan Maran Feb 28000 Temerloh FK506 Pahang Darul Makmur GCT Tel : ( 09)2955333 Ext : 1570 GFR GMC GS GVHD HA Hb HbsAg HCV HD HDL 204

Fifth Report of the National Transplant Registry 2008

APPENDIX D

Fifth Report of the Fifth Report of the National Transplant Registry 2008 National Transplant Registry 2008

APPENDIX C

Kidney Transplant Services APPENDIX C GLOSSARY MOH AIIRB Angiotensin II Receptor Blocker Hospital Sultan Ismail Pandan Hospital Sultan Ismail Pandan ACE Angiotensin Converting Enzyme Renal Transplant Clinic (Paed) Renal Transplant Clinic ADPKD Autosomal Dominant Polycystic Kidney Disease c/o Paediatrics Ward (Wad 8C & D) c/o Haemodialysis Unit AG Antigen Jalan Persiaran Mutiara Emas Utama Jalan Persiaran Mutiara Emas Utama ALL Acute Lymphocytic Leukaemia Taman Mount Austin Taman Mount Austin ALP 81100 Johor BahruAlkaline Phosphatase 81100 Johor Bahru ALT Alanine Transferase Johor Darul Takzim Johor Darul Takzim AML Tel : ( 07)3565000Acute ExtMyelogenous : 2013/8306 Leukaemia Tel : ( 07)3565000 Ext : 3508/3509 Apr April Fax : ( 07)3565088 Fax : ( 07)3565034 ASH Ampang Puteri Specialist Hospital ATG Anti-thymocyte globulin Aug Hospital Sultanah August Aminah Hospital Sultanah Bahiyah AVM Arterio-venous Malformation Renal Transplant Clinic Renal Transplant Clinic AZA c/o HaemodialysisAzathioprine Unit c/o Haemodialysis Unit BMI Body Mass Index 80590 Johor Bahru 06550 Alor Setar BMT Blood and Marrow Transplantation Johor Darul Takzim Kedah Darul Aman BP Blood Pressure Tel : ( 07)2231666 Ext : 2055 Tel : ( 04)7303333 Ext : 201/202 Fax : ( 07)2242694Brain Death Fax : ( 04)7341737 BD BID brought in dead CAPD Continuous Ambulatory Peritoneal Dialysis CD Death Hospital Sultanah Cardiac Nur Zahirah Hospital Taiping Renal Transplant Clinic RenalAnaemia Transplant Clinic CDA Congenital Dyserythropoeitic c/o HaemodialysisCounting Unit c/o Haemodialysis unit CF Fingers 20400 Kuala Terengganu CHD Coronary Heart Disease Jalan Taming Sari Terengganu DarulChronic Iman Kidney Disease 34000 Taiping CKD Perak Darul Ridzuan Tel : ( 09)6212121 Ext : 2054 CMV Cytomegalovirus Fax : ( 09)6221820 Tel 1 : ( 05)8083333 Ext : 8173 CRF Case Report Form Tel 2 : ( 05)8408173 Dec December Fax : ( 05)8053121 DF Deep Frozen DFS Disease-free Survival Hospital Tawau Hospital Tengku Ampuan Afzan FD Freeze Dried Renal Transplant Clinic Renal Transplant Clinic Feb February c/o Haemodialysis Unit c/o Haemodialysis Unit FK506 Tacrolimus 91007 Tawau 25100 Kuantan GCT Germ Cell Tumour Sabah Pahang Darul Makmur GFR Glomerular Filtration Rate Tel 1 : (089)773183 Tel : ( 09)5133333 Ext : 2340 GMC Gleneagles Medical Centre Tel 2 : (089)773533 Fax : ( 09)5164272 GS Gentamicin and Streptomycin Fax : (089)778626 GVHD Graft Versus Host Disease HA Hospital Ampang Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 205 185

Fifth Report of the National Transplant Registry 2008

APPENDIX D APPENDIX C

Fifth Report of the National Transplant Registry 2008

Kidney Transplant Services

APPENDIX C

MOH

GLOSSARY

Hospital Tengku Ampuan Rahimah Renal Transplant Clinic c/o Haemodialysis Unit Jalan Langat 41200 Klang Selangor Darul Ehsan Tel 1 : ( 03)33723333 Ext : 1411/1256 Tel 2 : ( 03)33757200 Fax : ( 03)33729089 Hospital Umum Sarawak Renal Transplant Clinic c/o Haemodialysis Unit Jalan Tun Ahmad Zaidi Adruce 93590 Kuching Sarawak Tel 1 : (082)276757 Tel 2 : (082)276528 Fax : (082)276734 PRIVATE Assunta Hospital Kidney Unit Jalan Templer 46990 Petaling Jaya Selangor Darul Ehsan Tel 1 : ( 03)77823433 Tel 2 : ( 03)76216696 Fax : ( 03)77814933

Ext : 254

Damai Medical & Heart Clinic Renal Transplant Clinic c/o Haemodialysis Centre 49-N, Jalan Ong Kim Wee 75300 Melaka Melaka Tel 1 : ( 06)2841204 Ext : 210/211 Tel 2 : ( 06)2844805 Fax : ( 06)2844805

AIIRB Hospital Tuanku Ja'afar ACE Renal Transplant Clinic ADPKD c/o Haemodialysis Unit AG Jalan Rasah ALL 70300 Seremban ALP Negeri Sembilan Darul Khusus ALT Tel 1 : ( 06)7684000 Ext : 4125 AML Tel 2 : ( 06)7604743 Apr Fax : ( 06)7684711 ASH ATG Aug AVM AZA BMI BMT BP BD BID CAPD CD CDA CF CHD C. S. Loo Kidney & Medical CKD Specialist Centre CMV Perak Community Specialist Hospital CRF 227, Jalan Kampar Dec 30250 Ipoh DF Perak Darul Ridzuan DFS Tel 1 : ( 05)2458918 FD Tel 2 : ( 05)2545594 Feb Fax : ( 05)2554288 FK506 GCT Fan Medical Renal Clinic GFR GMC Gleneagles Intan Medical Centre GS Suite 7.01, 7th Floor GVHD Medical Office Building HA 282, Jalan Ampang Hb 50450 Kuala Lumpur HbsAg Tel : ( 03)42578822 HCV Fax : ( 03)42523823 HD HDL 206

Fifth Report of the National Transplant Registryof2008 Fifth Report the Fifth Report of the National Transplant Registry 2008 National Transplant Registry 2008

APPENDIX D APPENDIX C

Kidney Transplant Services APPENDIX C PRIVATE GLOSSARY AIIRBDr Choo & Liew Angiotensin II ReceptorKPJ Blocker Klinik Ampang Puteri Specialist Hospital ACE Angiotensin Converting Enzyme 9-0, Lorong Lintas Plaza 1 Renal Transplant Clinic ADPKD Autosomal Dominant Polycystic Disease Lintas Plaza, Jalan Lintas Suite 1-7,Kidney First Floor AG Kota Kinabalu Antigen 88380 No.1, Jalan Mamanda 9 ALL Acute Lymphocytic Leukaemia Sabah Tmn Dato'Ahmad Razali ALP Alkaline Phosphatase Tel : (088)238292 68000 Ampang ALT: (088)237292 Alanine Transferase Selangor Darul Ehsan Fax AML Acute Myelogenous Leukaemia Tel : ( 03)42722500 Ext : 1250 Apr April Fax : ( 03)42702443 ASH Ampang Puteri Specialist Hospital ATGSelangor Specialist Anti-thymocyte KPJ Hospital globulinNormah Medical Specialist Centre Aug Transplant Clinic August Renal Renal Transplant Clinic AVM Arterio-venous Malformation c/o Haemodialysis Unit c/o Haemodialysis Centre AZA Azathioprine Lot 1, Jalan Singa 20/1, Seksyen 20 P.O. Box 3298 BMI Shah Alam Body Mass Index 40300 93764 Kuching Selangor Sarawak BMT Darul Ehsan Blood and Marrow Transplantation Tel Ext Pressure : 4533 Tel 1 : (082)440055 Ext : 260 BP : ( 03)55431111Blood Fax Tel 2 : (082)443785 BD : ( 03)55431722Brain Death Fax : (082)443787 BID brought in dead CAPD Continuous Ambulatory Peritoneal Dialysis CD Hospital Penang Cardiac Death Prince Court Medical Centre Pantai CDA Congenital Dyserythropoeitic Anaemia Clinic Renal Transplant Clinic Renal Transplant CF Haemodialysis Centre Counting Fingers c/o Renal Dialysis Unit c/o CHD Coronary Heart Disease Level 3 No. 82, Jalan Tengah, Bayan Baru 11900 CKD Bayan LepasChronic Kidney Disease39, Jalan Kia Peng 50450 Kuala Lumpur Pulau CMV Pinang Cytomegalovirus Tel ExtReport : 155 Form Wilayah Persekutuan CRF: ( 04)6433888 Case Fax : ( 04)6432888 Tel : ( 03)21600147 Ext : 2977 Dec December Fax : ( 03)31600930 DF Deep Frozen DFS Disease-free Survival FD Freeze Dried Sabah Medical Centre Renal Care, Ipoh Specialist Hospital Feb February Renal Transplant Clinic Renal Transplant Clinic FK506 Tacrolimus c/o Haemodialysis Centre c/o Renal Care GCT Germ Cell Tumour Kingfisher Park, Kuala Inanam Ipoh Specialist Hospital GFR Glomerular 88840 Kota Kinabalu 26, Jalan Raja Dihilir (Tambun)Filtration Rate GMC Gleneagles Medical Centre Sabah 30350 Ipoh GS Darul RidzuanGentamicin and Streptomycin Tel : (088)424333 Perak GVHD Graft Versus Host Disease Fax : (088)272622 Tel 1 : ( 05)2418777 Ext : 275/276 HA2 : ( 05)2413128Hospital Ampang Tel Hb : ( 05)2541388Haemoglobin Fax HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 207 185

Fifth Report of the National Transplant Registry 2008

APPENDIX D

Fifth Report of the National Transplant Registry 2008

APPENDIX C

Kidney Transplant Services

APPENDIX C GLOSSARY

PRIVATE Sime Darby Medical Centre Subang Jaya Renal Transplant Clinic c/o Clinic Dr Prasad 1, Jalan SS 12/1A 47500 Subang Jaya Selangor Darul Ehsan Tel : ( 03)56301212 Ext : 469 Fax : ( 03)56396188 Smartcare Dialysis Centre, Subang Jaya Klinik Pakar Dialisis 52G, Jalan USJ 10/1B 47620 Subang Jaya Selangor Darul Ehsan Tel : ( 03)56337618 Fax : ( 03)56330618

Sunway Medical Centre Renal Transplant Clinic c/o Haemodialysis Unit Suite A1-28, First Floor No 5, Jln Lagoon Selatan Bandar Sunway 46150 Petaling Jaya Selangor Darul Ehsan Tel 1 : ( 03)74919191 Ext : 7784 Tel 2 : ( 03)74911135 Fax : ( 03)74918181 Wee Kidney & Medical Specialist Clinic Suite 303A, 3rd Floor Mahkota Medical Centre No.3, Mahkota Melaka, Jalan Merdeka 75000 Melaka Melaka Tel 1 : ( 06)2818222 Ext : 3309 Tel 2 : ( 06)2813333 Fax : ( 06)2810560

AIIRB Simon Wong Medical & Kidney Clinic ACE Timberland Medical Centre ADPKD Lot 5160, Ground Floor AG Lorong 2, 2 1/2 miles Rock Road ALL 93250 Kuching ALP Sarawak ALT Tel 1 : (082)241242 AML Tel 2 : (082)234466 Apr Fax : (082)254242 ASH ATG Sri Kota Medical Centre Aug Renal Transplant Clinic AVM c/o Haemodialysis Centre AZA Jalan Mohet BMI 41000 Klang BMT Selangor Darul Ehsan BP Tel : ( 03)33733636 Ext : 7106 BD Fax : ( 03)33736888 BID CAPD Tan Medical Renal Clinic CD Healthcare Dialysis Centre CDA CF No. 41, Tingkat 1 CHD Jalan 6/31 CKD 46300 Petaling Jaya CMV Selangor Darul Ehsan CRF Tel : ( 03)77836423 Dec Fax : ( 03)77836422 DF DFS FD Feb FK506 GCT GFR GMC GS GVHD HA Hb HbsAg HCV HD HDL 208

Fifth Report of the National Transplant Registry 2008 Fifth Report of the Fifth Report of the National Transplant Registry 2008 National Transplant Registry 2008

APPENDIX D APPENDIX C

Kidney Transplant Services APPENDIX C UNIVERSITY GLOSSARY AIIRB Angiotensin II Receptor Blocker Pusat Perubatan Universiti Kebangsaan Universiti Sains Malaysia Hospital ACE Angiotensin Converting Enzyme Malaysia Renal Transplant Clinic ADPKD Autosomal Dominant Polycystic Kidney Disease Renal Transplant Clinic (Medical 3) c/o Haemodialysis Unit AG Antigen Jalan Tenteram 16150 Kubang Kerian ALL Acute Lymphocytic Leukaemia Bandar Tun Razak, Cheras Kelantan Darul Naim ALP Alkaline Phosphatase 56300 Kuala lumpur Tel 1 : ( 09)7673328 ALT Alanine Transferase Wilayah Persekutuan Tel 2 : ( 09)7673329 AML Acute Myelogenous Tel 1 : ( 03)91455555 Ext : 7318 Leukaemia Fax : ( 09)7652198 Apr April Tel 2 : ( 03)91703831 Fax : ( 03)91735316 ASH Ampang Puteri Specialist Hospital ATG Anti-thymocyte globulin Aug August University of Malaya Medical Centre AVM Arterio-venous Malformation Renal Transplant Clinic AZA Azathioprine c/o Ward 8TE Dialysis BMI Body Unit Mass Index Jalan Universiti BMT Blood and Marrow Transplantation 59100 Kuala Lumpur BP Blood Pressure Wilayah Persekutuan BD Brain Death Tel 1 : ( 03)79494422 Ext : 2282/3093 BID brought in dead Tel 2 : ( 03)79492282 CAPD Continuous Ambulatory Peritoneal Dialysis Fax : ( 03)79568822 CD Cardiac Death CDA Congenital Dyserythropoeitic Anaemia CF Counting Fingers CHD Coronary Heart Disease CKD Chronic Kidney Disease CMV Cytomegalovirus CRF Case Report Form Dec December DF Deep Frozen DFS Disease-free Survival FD Freeze Dried Feb February FK506 Tacrolimus GCT Germ Cell Tumour GFR Glomerular Filtration Rate GMC Gleneagles Medical Centre GS Gentamicin and Streptomycin GVHD Graft Versus Host Disease HA Hospital Ampang Hb Haemoglobin HbsAg Hepatitis B surface Antigen HCV Hepatitis C Virus HD Haemodialysis HDL High Density Lipoprotein 209 185

Fifth Report of the National Transplant Registry 2008

APPENDIX D

Fifth Report of the National Transplant Registry 2008

APPENDIX C

Liver Transplant Services

APPENDIX C

MOH

GLOSSARY AIIRB Hospital Selayang ACE Department of Hepatobiliary ADPKD Lebuhraya Selayang-Kepong AG 68100 Batu Caves ALL Selangor Darul Ehsan Tel : ( 03)61203233 ExtALP : 3314 ALT Fax : ( 03)61207564 AML Apr ASH ATG Aug AVM AZA BMI BMT BP BD BID CAPD CD CDA CF CHD CKD CMV CRF Dec DF DFS FD Feb FK506 GCT GFR GMC GS GVHD HA Hb HbsAg HCV HD HDL

Hospital Kuala Lumpur Institute Paediatric Jalan Pahang 50586 Kuala Lumpur Tel : ( 03)26906211 Fax : ( 03)26913815 Hospital Selayang Paediatric Hepatology Unit Lebuhraya Selayang-Kepong 68100 Batu Caves Selangor Darul Ehsan Tel : ( 03)61203233 Fax : ( 03)61207564

PRIVATE Sime Darby Medical Centre Subang Jaya 1, Jalan SS 12/1A 47500 Subang Jaya Selangor Darul Ehsan Tel : ( 03)56306193 Fax : ( 03)56306209

UNIVERSITY University of Malaya Medical Centre Department of Paediatrics Jalan Universiti 59100 Kuala Lumpur Tel : ( 03)79492065 Fax : ( 03)79556114

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