Transcript Slide 1

CHAPTER 13
Renal Transplantation
Goh Bak Leong
Fan Kin Sing
Rohan Malek Bin Dato’ Dr. Johan
Rosnawati Yahya
S. Prasad Menon
Tan Si Yen
Wong Hin Seng
Source: 20th MDTR Report 2012, NRR
Table 13.1.1:
Stock and flow of renal transplantation, 1993-2012
Year
1993 1994 1995 1996 1997 1998 1999 2000 2001
200
2
New transplant patients
140
204
105
151
129
106
128
144
162
172
Died
24
30
17
37
32
28
29
32
40
38
Graft failure
20
22
27
24
35
48
36
30
39
33
Lost to Follow up
0
2
2
0
0
1
1
5
2
2
Functioning graft at 31st December
144
3
201
2003 2004 2005 2006 2007 2008 2009 2010 2011
2
734
884
943 1033 1095 1124 1186 1263 1344
New transplant patients
162
192
171
151
111
130
141
128
122
94
Died
41
44
48
58
47
59
49
47
54
46
Graft failure
41
43
21
36
36
39
37
46
42
41
Lost to Follow up
4
6
6
3
12
13
12
6
9
9
Year
Functioning graft at 31st December
1519 1618 1714 1768 1784 1803 1846 1875 1892
189
4
Source: 20th MDTR Report 2012, NRR
Figure 13.1.1: Stock and flow of renal transplantation, 1993-2012
Functioning graft at 31st Dec
New patients
2,000
1,800
No. of patients
1,600
1,400
1,200
1,000
800
600
400
200
0
'93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12
Year
Source: 20th MDTR Report 2012, NRR
Table 13.1.2:
New transplant rate per million population (pmp), 19932012
Year
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
New transplant patients
140
204
105
151
129
106
128
144
162
172
7
10
5
7
6
5
6
6
7
7
New transplant rate (pmp)
Year
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
New transplant patients
162
192
171
151
111
130
141
128
122
94
6
7
6
6
4
5
5
5
4
3
New transplant rate (pmp)
Source: 20th MDTR Report 2012, NRR
Figure 13.1.2: New transplant rate, 1993-2012
Rate, pmp
10
New Transplant rate, pmp
9
8
7
6
5
4
3
2
1
0
'93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12
Year
Source: 20th MDTR Report 2012, NRR
Table 13.1.3:
Transplant prevalence rate per million population
(pmp), 1993-2012
Year
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Functioning graft at 31st
December
734
884
943 1033 1095 1124 1186 1263 1344 1443
Transplant prevalence rate (pmp)
37
44
46
49
50
50
52
54
56
58
Year
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Functioning graft at 31st
December
1519 1618 1714 1768 1784 1803 1846 1875 1892 1894
Transplant prevalence rate (pmp)
60
62
65
66
66
65
66
66
66
65
Source: 20th MDTR Report 2012, NRR
Figure 13.1.3: Transplant prevalence rate, 1993-2012
Rate, pmp
Transplant Prevalence rate, pmp
70
60
50
40
30
20
10
0
'93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12
Year
Source: 20th MDTR Report 2012, NRR
Table 13.2.1:
Renal transplant recipients’ characteristics, 1993-2012
Year
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
New Transplant Patients
140 204 105 151 129 106 128 144 162 172
Age at transplant (years), Mean 38
38
35
38
36
37
37
39
41
40
Age at transplant (years), SD
13
11
11
11
12
11
13
14
13
12
% Male
60
67
59
56
64
58
63
65
62
58
% Diabetic (co-morbid/ primary
11
12
13
10
11
10
11
16
19
15
renal disease)
% HbsAg positive
9
10
7
13
5
6
4
5
5
7
% Anti-HCV positive
23
13
16
19
7
18
11
8
15
8
Year
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
New Transplant Patients
162 192 171 151 111 130 141 128 122 94
Age at transplant (years), Mean 42
42
38
37
37
37
38
40
38
37
Age at transplant (years), SD
13
13
14
15
16
14
14
14
15
13
% Male
66
63
68
66
64
59
64
66
70
60
% Diabetic (co-morbid/ primary
23
21
21
18
15
18
20
20
14
16
renal disease)
% HbsAg positive
8
5
5
6
9
3
2
4
4
3
% Anti-HCV positive
10
8
3
8
9
3
7
3
4
2
Source: 20th MDTR Report 2012, NRR
Table 13.2.2:
Primary causes of end stage renal failure, 1993-2012
Source: 20th MDTR Report 2012, NRR
Table 13.3.1:
Type of renal transplantation, 1993-2012
Source: 20th MDTR Report 2012, NRR
Table 13.3.2:
Place of transplantation, 1993-2012
Source: 20th MDTR Report 2012, NRR
Table 13.4.1:
Post-transplant complications, 1993-2012
Source: 20th MDTR Report 2012, NRR
Table 13.4.2:
Biochemical data, 2004-2012
Source: 20th MDTR Report 2012, NRR
Table 13.4.3:
Transplant patients’ death rate and graft loss, 19932012
Year
Number at risk
Transplant death
Transplant death rate %
Graft loss
Graft loss rate %
Acute rejection
Acute rejection rate %
All losses
All losses rate %
1993
734
24
3.3
20
2.7
0
0
44
6
1994
809
30
3.7
22
2.7
0
0
52
6.4
1995
914
17
1.9
27
3
0
0
44
4.8
1996
988
37
3.7
24
2.4
0
0
61
6.2
1997
1064
32
3
35
3.3
0
0
67
6.3
1998
1110
28
2.5
48
4.3
0
0
76
6.8
1999
1155
29
2.5
36
3.1
0
0
65
5.6
2000
1225
32
2.6
30
2.4
1
0.1
62
5.1
2001
1304
40
3.1
39
3
0
0
79
6.1
2002
1394
38
2.7
33
2.4
0
0
71
5.1
Year
Number at risk
Transplant death
Transplant death rate %
Graft loss
Graft loss rate %
Acute rejection
Acute rejection rate %
All losses
All losses rate %
2003
1481
41
2.8
41
2.8
4
0.3
82
5.5
2004
1569
44
2.8
43
2.7
19
1.2
87
5.5
2005
1666
48
2.9
21
1.3
14
0.8
69
4.1
2006
1741
58
3.3
36
2.1
19
1.1
94
5.4
2007
1776
47
2.6
36
2
14
0.8
83
4.7
2008
1794
59
3.3
39
2.2
24
1.3
98
5.5
2009
1825
49
2.7
37
2
32
1.8
86
4.7
2010
1861
47
2.5
46
2.5
81
4.4
93
5
2011
1884
54
2.9
42
2.2
53
2.8
96
5.1
2012
1893
45
2.4
41
2.2
20
1.1
86
4.5
Source: 20th MDTR Report 2012, NRR
Figure 13.4.3(a): Transplant recipient death rate, 1993-2012
Annual death rate
3.5
Death rate %
3
2.5
2
1.5
1
.5
0
'93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12
Year
Source: 20th MDTR Report 2012, NRR
Figure 13.4.3(b): Transplant recipient graft loss rate, 1993-2012
Annual graft loss rate
4.5
4
Graft loss rate %
3.5
3
2.5
2
1.5
1
.5
0
'93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12
Year
Source: 20th MDTR Report 2012, NRR
Table 13.4.4(a): Causes of death in transplant recipients, 1993-2012
Source: 20th MDTR Report 2012, NRR
Table 13.4.4(b): Causes of graft failure, 1993-2012
Source: 20th MDTR Report 2012, NRR
Table 13.5.1.1: Patient survival, 1993-2012
Interval (years)
n
% Survival
SE
0
2879
100
1
2553
95
0
2
2357
93
0
3
2162
92
1
4
1959
90
1
5
1783
88
1
6
1603
86
1
7
1409
84
1
8
1208
83
1
9
1020
81
1
10
872
79
1
Source: 20th MDTR Report 2012, NRR
Figure 13.5.1.1: Patient survival, 1993-2012
Transplant patient survival, 1993-2012
1.00
0.75
0.50
0.25
0.00
0
2
4
6
8
10
12
Duration in years
14
16
18
20
Source: 20th MDTR Report 2012, NRR
Table 13.5.1.2: Risk factors for transplant patient survival 1993-2012
Source: 20th MDTR Report 2012, NRR
Table 13.5.1.3: Graft survival, 1993-2012
Interval (years)
n
% Survival
2879
100
1
2553
92
1
2
2357
89
1
3
2162
86
1
4
1959
83
1
5
1783
80
1
6
1603
77
1
7
1409
73
1
8
1208
71
1
9
1020
68
1
10
872
65
1
0
SE
Source: 20th MDTR Report 2012, NRR
Figure 13.5.1.3: Graft survival, 1993-2012
Transplant graft survival, 1993-2012
1.00
0.75
0.50
0.25
0.00
0
2
4
6
8
10
12
Duration in years
14
16
18
20
Source: 20th MDTR Report 2012, NRR
Table 13.5.1.4: Risk factors for transplant graft survival 1993-2012
Source: 20th MDTR Report 2012, NRR
Table 13.5.2.1: Unadjusted patient survival by type of transplant, 19932012
Type of
Transplant
Commercial
Cadaver
Interval (years)
n
% Survival SE
0
1252
100
1
2
3
4
5
6
7
8
9
10
1165
1127
1079
1005
914
844
740
628
500
416
96
94
92
89
87
85
83
83
81
79
*n=Number at risk
Commercial
Live Donor
1
1
1
1
1
1
1
1
1
1
n
Live Donor
% Survival SE
423
100
383
345
297
263
243
220
193
180
161
152
97
95
92
90
87
84
80
77
74
72
1
1
1
2
2
2
2
2
3
3
n
Cadaver
% Survival SE
745
100
637
588
541
485
447
394
355
304
272
239
97
96
96
94
94
93
91
90
88
88
1
1
1
1
1
1
1
1
1
2
n
%Survival SE
379
100
285
232
194
163
142
113
95
83
74
59
89
86
84
83
80
78
77
75
73
71
2
2
2
2
2
3
3
3
3
3
SE=standard error
Source: 20th MDTR Report 2012, NRR
Figure 13.5.2.1: Patient survival by type of transplant, 1993-2012
Transplant patient survival by Type of Transplant, 1993-2012
1.00
Live donor
0.75
Cadaver
Commercial cadaver
0.50
Commercial live donor
0.25
0.00
0
2
4
6
8
10
12
14
Duration in years
16
18
20
22
Source: 20th MDTR Report 2012, NRR
Table 13.5.2.2: Graft survival by type of transplant, 1993-2012
Type of
Transplant
Interval (years)
Commercial
Cadaver
n
% Survival SE
0
1252
100
1
2
3
4
5
6
7
8
9
10
1167
1129
1081
1007
916
847
742
629
504
418
94
91
89
85
82
80
77
74
72
70
*n=Number at risk
Commercial
Live Donor
1
1
1
1
1
1
1
1
1
1
n
Live Donor
% Survival SE
423
100
392
353
306
271
251
227
198
182
162
153
95
91
86
82
77
72
66
63
59
55
1
1
2
2
2
2
3
3
3
3
n
Cadaver
% Survival SE
745
100
638
584
542
488
446
394
353
301
267
234
92
91
90
87
86
83
81
78
75
71
1
1
1
1
1
2
2
2
2
2
n
% Survival SE
379
100
286
232
195
163
142
113
96
83
74
59
81
76
73
70
67
63
61
58
56
51
2
2
2
3
3
3
3
3
3
4
SE=standard error
Source: 20th MDTR Report 2012, NRR
Figure 13.5.2.2: Graft survival by type of transplants, 1993-2012
Transplant graft survival by Type of Transplant, 1993-2012
1.00
0.75
Live donor
0.50
Commercial cadaver
Cadaver
Commercial live donor
0.25
0.00
0
2
4
6
8
10
12
14
Duration in years
16
18
20
22
Source: 20th MDTR Report 2012, NRR
Table 13.5.3.1: Patient survival by year of transplant (Living related
transplant, 1993-2012)
Year of Transplant
Interval (years)
n
1993-2002
% Survival
0
328
100
1
2
3
4
5
6
7
8
9
10
298
296
285
276
271
259
248
238
228
217
98
97
96
96
95
95
94
93
92
91
SE
1
1
1
1
1
1
1
2
2
2
n
2003-2012
% Survival
278
100
226
197
175
141
115
93
67
37
19
1
96
96
95
93
93
89
88
88
83
83
SE
1
1
1
2
2
2
3
3
5
5
Source: 20th MDTR Report 2012, NRR
Figure 13.5.3.1: Patient survival by year of transplant (Living related
transplant, 1993-2012)
Transplant patient survival by Year of Transplant, 1993-2012
1.00
Year 2003-2012
Year 1993-2002
0.75
0.50
0.25
0.00
0
2
4
6
8
10
12
Duration in years
14
16
18
20
Source: 20th MDTR Report 2012, NRR
Table13.5.3.2: Graft survival by year of transplant (Living related
transplant, 1993-2012)
Year of Transplant
Interval (years)
n
1993-2002
% Survival
0
328
100
1
2
3
4
5
6
7
8
9
10
322
320
309
299
293
281
270
257
244
233
90
90
87
84
83
79
77
73
70
67
SE
2
2
2
2
2
2
2
2
2
3
n
2003-2012
% Survival
278
100
317
264
233
189
153
113
83
45
23
1
94
92
92
89
88
85
84
84
84
77
SE
1
1
1
2
2
2
2
2
2
7
Source: 20th MDTR Report 2012, NRR
Figure 13.5.3.2: Graft survival by year of transplant (Living related
transplant, 1993-2012)
Transplant graft survival by Year of Transplant, 2002-2012
1.00
Year 2003-2012
0.75
Year 1993-2002
0.50
0.25
0.00
0
2
4
6
8
10
12
Duration in years
14
16
18
20
Source: 20th MDTR Report 2012, NRR
Table 13.5.4.1: Patient survival by year of transplant (Commercial
cadaver transplant, 1993-2012)
Year of Transplant
Interval (years)
n
1993-2002
% Survival
0
642
100
1
2
3
4
5
6
7
8
9
10
601
585
569
536
510
491
466
448
432
416
95
93
91
88
86
84
81
81
79
78
SE
1
1
1
1
1
1
2
2
2
2
n
2003-2012
% Survival
610
100
566
544
517
471
406
356
276
181
75
2
96
94
92
91
89
88
87
86
85
85
SE
1
1
1
1
1
1
2
2
2
2
Source: 20th MDTR Report 2012, NRR
Figure 13.5.4.1: Patient survival by year of transplant (Commercial
cadaver transplant, 1993-2012)
Transplant patient survival by Year of Transplant, 1993-2012
1.00
Year 2003-2012
0.75
Year 1993-2002
0.50
0.25
0.00
0
2
4
6
8
10
12
Duration in years
14
16
18
20
Source: 20th MDTR Report 2012, NRR
Table 13.5.4.2: Graft survival by year of transplant (Commercial
cadaver transplant, 1993-2012)
Year of Transplant
Interval (years)
n
1993-2002
% Survival
0
642
100
1
2
3
4
5
6
7
8
9
10
601
585
569
536
510
491
466
448
432
416
94
91
88
84
80
77
74
72
70
67
SE
1
1
1
1
2
2
2
2
2
2
n
2003-2012
% Survival
610
100
566
544
517
471
406
356
276
181
75
2
94
92
89
87
85
82
80
78
77
77
SE
1
1
1
1
1
2
2
2
2
2
Source: 20th MDTR Report 2012, NRR
Figure 13.5.4.2: Graft survival by year of transplant (Commercial
cadaver transplant, 1993-2012)
Transplant graft survival by Year of Transplant, 1993-2012
1.00
Year 2003-2012
0.75
Year 1993-2002
0.50
0.25
0.00
0
2
4
6
8
10
12
Duration in years
14
16
18
20
Source: 20th MDTR Report 2012, NRR
Table 13.6.1: Medication data, 2004-2012
Source: 20th MDTR Report 2012, NRR
Figure 13.6.1(a)(i): Calcineurin inhibitors: Cyclosporin vs Tacrolimus
CsA
Tacrolimus
80
Proportion of patients
70
60
50
40
30
20
10
0
'04
'05
'06
'07
'08
'09
'10
'11
'12
Year
Source: 20th MDTR Report 2012, NRR
Figure 13.6.1(a)(ii): Antimetabolites: Azathioprine vs Mycophenolic
Acid
Azathioprine
Mycophenolic Acid
Proportion of patients
70
60
50
40
30
20
10
0
'04
'05
'06
'07
'08
'09
'10
'11
'12
Year
Source: 20th MDTR Report 2012, NRR
Table 13.6.2: Use of anti-hypertensive medications
Source: 20th MDTR Report 2012, NRR
Table 13.7.1: Risk factors for IHD in renal transplant recipients at year
2004-2012
Diabetes
Hypertension**
CKD
Diabetes + Hypertension**
Diabetes + CKD
CKD + Hypertension**
Diabetes + CKD +
Hypertension**
Diabetes
Hypertension**
CKD
Diabetes + Hypertension**
Diabetes + CKD
CKD + Hypertension**
Diabetes + CKD +
Hypertension**
2004
27 (1.8)
501 (34.1)
121 (8.2)
149 (10.1)
21 (1.4)
530 (36.1)
2005
21 (1.4)
508 (33.1)
142 (9.3)
163 (10.6)
20 (1.3)
537 (35.0)
2006
21 (1.4)
452 (30.9)
177 (12.1)
158 (10.8)
18 (1.2)
489 (33.4)
2007
25 (1.6)
586 (37.2)
127 (8.1)
179 (11.4)
11 (0.7)
515 (32.7)
2008
18 (1.1)
662 (41.7)
117 (7.4)
204 (12.8)
22 (1.4)
456 (28.7)
120 (8.2)
143 (9.3) 148 (10.1) 134 (8.5)
110 (6.9)
2009
28 (1.8)
644 (41.0)
156 (9.9)
164 (10.4)
18 (1.1)
472 (30.1)
2010
35 (2.1)
635 (37.8)
166 (9.9)
197 (11.7)
22 (1.3)
514 (30.6)
2011
38 (2.2)
674 (38.9)
159 (9.2)
215 (12.4)
33 (1.9)
508 (29.3)
2012
37 (2.2)
596 (36.1)
225 (13.6)
203 (12.3)
33 (2.0)
457 (27.7)
88 (5.6)
109 (6.5)
105 (6.1)
100 (6.1)
**Hypertension: BP systolic > 140 and BP diastolic > 90, or on anti-hypertensive drugs
Source: 20th MDTR Report 2012, NRR
Figure 13.7.1(a): Venn diagram for pre and post transplant
complications (in %) at year 2004
CKD
8,2
36.1
1.4
8.2
34.1
HPT
10.1
1.8
DM
Source: 20th MDTR Report 2012, NRR
Figure 13.7.1(b): Venn diagram for pre and post transplant
complications (in %) at year 2006
CKD
12.1
33.4
1.2
10.1
1.4
30.9
HPT
10.8
DM
Source: 20th MDTR Report 2012, NRR
Figure 13.7.1(c): Venn diagram for pre and post transplant
complications (in %) at year 2008
CKD
9.9
28.7
1.4
6.9
41.7
HPT
12.8
1.1
DM
Source: 20th MDTR Report 2012, NRR
Figure 13.7.1(d): Venn diagram for pre and post transplant
complications (in %) at year 2010
CKD
9.9
30.6
1.3
6.5
2.2
37.8
HPT
11.7
DM
Source: 20th MDTR Report 2012, NRR
Figure 13.7.1(e): Venn diagram for pre and post transplant
complications (in %) at year 2012
CKD
12.3
27.7
2.0
6.1
2.2
36.1
HPT
13.6
DM
Source: 20th MDTR Report 2012, NRR
Table 13.7.2(a): Systolic BP, 2004-2012
Year
2004
2005
2006
2007
2008
n
%
n
%
n
%
n
%
n
%
<120
208
13
234
14
252
16
244
14
296
17
120-129
345
22
318
19
398
25
396
23
384
22
130-139
468
30
480
29
486
30
540
32
620
36
140-159
429
27
455
28
356
22
412
24
336
19
160-179
102
6
136
8
93
6
99
6
79
5
>=180
23
1
24
1
19
1
17
1
11
1
Year
2009
2010
2011
2012
n
%
n
%
n
%
n
%
<120
270
16
348
19
357
18
346
18
120-129
376
22
402
21
424
22
564
29
130-139
650
38
688
37
651
34
594
31
140-159
344
20
328
17
424
22
375
19
160-179
62
4
101
5
65
3
48
2
>=180
10
1
10
1
21
1
13
1
Source: 20th MDTR Report 2012, NRR
Figure 13.7.2(a): Systolic BP, 2004-2012
Systolic BP <120
Systolic BP 120-129
Systolic BP 130-139
Systolic BP 140-159
Systolic BP 160-179
Systolic BP >=180
100
Percent
80
60
40
20
0
2004
2005
2006
2007
2008
Year
2009
2010
2011
2012
Source: 20th MDTR Report 2012, NRR
Table 13.7.2(b): Diastolic BP, 2004-2012
Year
<80
80-84
85-89
90-99
100-109
>=110
2004
n
524
614
48
321
56
12
Year
<80
80-84
85-89
90-99
100-109
>=110
2005
%
33
39
3
20
4
1
n
526
660
74
312
65
10
%
32
40
4
19
4
1
2009
n
866
533
84
197
27
5
2006
n
632
589
74
244
61
4
2007
n
39
37
5
15
4
0
2010
%
51
31
5
12
2
0
n
971
557
114
204
27
4
%
711
617
74
262
39
5
2011
%
52
30
6
11
1
0
n
927
629
142
219
22
3
2008
n
42
36
4
15
2
0
%
908
537
51
202
23
5
n
53
31
3
12
1
0
2012
%
48
32
7
11
1
0
n
1089
522
171
143
20
5
%
56
27
9
7
1
0
Source: 20th MDTR Report 2012, NRR
Figure 13.7.2(b): Diastolic BP, 2004-2012
Diastolic BP <80
Diastolic BP <85
Diastolic BP 85-89
Diastolic BP 90-99
Diastolic BP 100-109
Diastolic BP >=110
100
Percent
80
60
40
20
0
2004
2005
2006
2007
2008
Year
2009
2010
2011
2012
Source: 20th MDTR Report 2012, NRR
Table 13.7.3: CKD stages, 2004-2012
Year
2004
2005
2006
2007
2008
n
%
n
%
n
%
n
%
n
%
Stage 1
119
8
119
7
117
7
180
11
165
10
Stage 2
579
37
583
36
542
34
598
35
636
37
Stage 3
738
47
805
49
803
50
773
46
751
44
Stage 4
113
7
113
7
109
7
116
7
123
7
Stage 5
15
1
19
1
24
2
23
1
27
2
Year
2009
2010
2011
2012
n
%
n
%
n
%
n
%
Stage 1
169
10
237
13
227
12
224
12
Stage 2
605
36
652
35
754
39
772
40
Stage 3
777
46
773
42
772
40
749
39
Stage 4
107
6
131
7
133
7
141
7
Stage 5
22
1
51
3
25
1
38
2
Source: 20th MDTR Report 2012, NRR
Figure 13.7.3: CKD stages by year
CKD Stage 1
CKD Stage 2
CKD Stage 4
CKD Stage 5
CKD Stage 3
100
Percent
80
60
40
20
0
2004
2005
2006
2007
2008
Year
2009
2010
2011
2012
Source: 20th MDTR Report 2012, NRR
Table 13.7.4: BMI, 2004-2012
Year
<20
20-25
25-30
> 30
Year
<20
20-25
25-30
> 30
2004
n
248
487
575
265
2005
%
16
31
37
17
2009
n
272
450
705
285
n
272
467
616
292
2006
%
17
28
37
18
n
266
445
626
267
2010
%
16
26
41
17
n
309
500
731
337
%
17
28
39
17
2007
n
262
474
653
319
2011
%
16
27
39
18
n
301
536
746
359
2008
%
15
28
38
19
n
259
464
730
273
%
15
27
42
16
2012
%
15
28
38
18
n
285
633
692
344
%
15
32
35
18
Source: 20th MDTR Report 2012, NRR
Figure 13.7.4: BMI, 2004-2012
BMI <20
BMI 20-25
BMI 25-30
BMI > 30
100
Percent
80
60
40
20
0
2004
2005
2006
2007
2008
Year
2009
2010
2011
2012
Source: 20th MDTR Report 2012, NRR
Table 13.7.5(a): LDL, 2004-2012
Year
2004
2005
2006
2007
2008
n
%
n
%
n
%
n
%
n
%
< 2.6
287
18
424
26
497
31
531
31
595
34
2.6-3.4
962
61
865
53
741
46
794
46
792
46
>= 3.4
326
21
358
22
366
23
383
22
339
20
Year
2009
2010
2011
2012
n
%
n
%
n
%
n
%
< 2.6
651
38
635
34
614
32
656
34
2.6-3.4
727
42
895
48
982
51
935
48
>= 3.4
334
20
347
18
346
18
363
19
Source: 20th MDTR Report 2012, NRR
Figure 13.7.5(a): LDL, 1993-2012
LDL <2.6
LDL 2.6-3.4
LDL >= 3.4
100
Percent
80
60
40
20
0
2004
2005
2006
2007
2008
Year
2009
2010
2011
2012
Source: 20th MDTR Report 2012, NRR
Table 13.7.5(b): Total cholesterol, 2004-2012
Year
2004
2005
2006
2007
2008
n
%
n
%
n
%
n
%
n
%
<4.1
116
7
160
10
162
10
215
13
211
12
4.1-5.1
422
27
460
28
492
31
544
32
543
31
5.1-6.2
761
48
777
47
706
44
730
43
736
43
6.2- 7.2
200
13
174
11
174
11
159
9
162
9
> 7.2
116
7
160
10
162
10
215
13
211
12
Year
2009
2010
2011
2012
n
%
n
%
n
%
n
%
<4.1
233
14
272
14
301
15
258
13
4.1-5.1
513
30
557
30
629
32
668
34
5.1-6.2
731
43
828
44
799
41
815
42
6.2- 7.2
159
9
151
8
138
7
150
8
> 7.2
76
4
69
4
75
4
63
3
Source: 20th MDTR Report 2012, NRR
Figure 13.7.5(b): Total cholesterol, 2004-2012
Total Cholesterol <4.1
Total Cholesterol 4.1-5.1
Total Cholesterol 5.1-6.2
Total Cholesterol 6.2-7.2
Total Cholesterol > 7.2
100
Percent
80
60
40
20
0
2004
2005
2006
2007
2008
Year
2009
2010
2011
2012
Source: 20th MDTR Report 2012, NRR
Table 13.7.5(c): HDL, 2004-2012
Year
2004
2005
2006
2007
2008
n
%
n
%
n
%
n
%
n
%
<1
89
6
119
7
106
7
110
6
119
7
1-1.3
258
16
315
19
302
19
355
21
387
22
>1.3
1228
78
1213
74
1196
75
1243
73
1220
71
Year
2009
2010
2011
2012
n
%
n
%
n
%
n
%
<1
153
9
148
8
136
7
135
7
1-1.3
424
25
412
22
440
23
461
24
>1.3
1135
66
1317
70
1366
70
1358
69
Source: 20th MDTR Report 2012, NRR
Figure 13.7.5(c): HDL, 2004-2012
HDL <1
HDL 1-1.3
HDL > 1.3
100
Percent
80
60
40
20
0
2004
2005
2006
2007
2008
Year
2009
2010
2011
2012
Source: 20th MDTR Report 2012, NRR
Table 13.7.6(a): Treatment for hypertension, 2004-2012
% on anti% on 1 anti% on 2 anti% on 3 antihypertensive drug hypertensive drug hypertensive drug hypertensive drug
Year
n
2004
1566
81
41
31
9
2005
1639
80
38
29
11
2006
1599
75
37
25
11
2007
1695
80
34
32
12
2008
1705
72
35
27
10
2009
1701
74
37
28
8
2010
1864
75
41
24
8
2011
1924
75
44
22
8
2012
1940
68
39
23
6
Source: 20th MDTR Report 2012, NRR
Table 13.7.6(b): Distribution of systolic BP without anti-hypertensive,
2004-2012
Year
n
Mean
SD
Median
LQ
UQ
% Patients ≥ 160mmHg
2004
262
126.7
13.5
130
120
132
4
2005
295
127.4
15.9
130
120
140
4
2006
356
124.7
14.3
120
119.5
130
3
2007
281
125.8
16.4
123
115
138
4
2008
271
124
14.8
120
113
130
3
2009
337
124.4
15.1
121
112
130
2
2010
397
128.5
36.7
124
119
137
5
2011
414
125.1
15.1
124
115
131
3
2012
569
127.3
24.9
126
117.5
132.5
2
Source: 20th MDTR Report 2012, NRR
Table 13.7.6(c): Distribution of diastolic BP without anti-hypertensive,
2004-2012
Year
n
Mean
SD
Median
LQ
UQ
% patients ≥ 90mmHg
2004
262
78.4
9.6
80
70
80
19
2005
295
79.1
9.2
80
70
81
19
2006
356
77.6
10
80
70
80
15
2007
281
76.7
9.7
80
70
80
13
2008
270
75.8
9.5
80
70
80
11
2009
337
77.6
9.2
80
70
80
14
2010
396
77.3
10
80
70
82
15
2011
414
77.1
9.2
80
70
80
11
2012
569
77.6
13
77.5
71.8
82.3
7
Source: 20th MDTR Report 2012, NRR
Table 13.7.6(d): Distribution of systolic BP on anti-hypertensives, 20042012
Year
n
Mean
SD
Median
LQ
UQ
% Patients ≥ 160mmHg
2004
1240
133.4
16.4
130
120
140
9
2005
1287
134.8
17.2
130
120
144
11
2006
1172
132.5
16.4
130
120
140
9
2007
1306
132.9
15.9
130
120
140
8
2008
1182
130.3
16.8
130
120
140
7
2009
1120
131.6
15.9
130
120
140
6
2010
1260
130.6
16.2
130
120
140
7
2011
1339
131.7
16.1
130
120
140
6
2012
1261
132.8
18.3
130.5
123.3
140
4
Source: 20th MDTR Report 2012, NRR
Table 13.7.6(e): Distribution of diastolic BP on anti-hypertensives,
2004-2012
Year
n
Mean
SD
Median
LQ
UQ
% Patients ≥ 90 mmHg
2004
1240
80.7
9.8
80
75
90
27
2005
1287
80.9
9.4
80
76
90
26
2006
1172
79.3
10
80
70
86
22
2007
1305
79.2
9.6
80
70
85
21
2008
1168
77.6
10.1
80
70
80
17
2009
1118
78.3
9.5
80
70
82
16
2010
1255
77.9
22
80
70
82
14
2011
1339
77.8
9.8
80
70
83
15
2012
1261
78.6
9.9
79
73
83
10
Source: 20th MDTR Report 2012, NRR
Table 13.8.3.1: Allograftraft and patient survival, Azathioprine vs
Mycophenolic Acid 1993-2012
Azathioprine
Survival (%)
Mycophenolic Acid
n
Graft
Patient
n
Graft
Patient
1 year
1487
100
100
1564
100
100
3 years
1248
84
91
1095
88
92
5 years
1129
77
86
823
84
89
10 years
869
61
77
211
72
82
Source: 20th MDTR Report 2012, NRR
Figure 13.8.3.1(a): Graft survival, Azathioprine vs Mycophenolic Acid
1993-2012
Graft survival, 2012
1.00
Mycophenolic Acid
Azathioprine
0.75
0.50
0.25
0.00
0
10
20
30
40
50
60
70
80
Duration in months
90
100 110 120
Source: 20th MDTR Report 2012, NRR
Figure 13.8.3.1(b): Patient survival, Azathioprine vs Mycophenolic
Acid, 1993-2012
Transplant patient survival, 2012
1.00
Mycophenolic Acid
Azathioprine
0.75
0.50
0.25
0.00
0
10
20
30
40
50
60
70
80
Duration in months
90
100 110 120
Source: 20th MDTR Report 2012, NRR
Table 13.8.3.2: Graft and patient survival, CsA vs Tacrolimus
CsA
Survival (%)
Tacrolimus
n
Graft
Patient
n
Graft
Patient
1 year
2111
100
100
969
100
100
3 years
1401
87
92
588
87
91
5 years
1231
81
88
394
83
89
10 years
722
66
80
71
68
82
Source: 20th MDTR Report 2012, NRR
Figure 13.8.3.2(a): Graft survival, CsA vs Tacrolimus, 1993-2012
Graft survival, 2012
1.00
Tacrolimus
CsA
0.75
0.50
0.25
0.00
0
10
20
30
40
50
60
70
80
Duration in months
90
100 110 120
Source: 20th MDTR Report 2012, NRR
Figure 13.8.3.2(b): Patient survival, CsA vs Tacrolimus, 1993-2012
Transplant patient survival, 2012
1.00
Tacrolimus
CsA
0.75
0.50
0.25
0.00
0
10
20
30
40
50
60
70
80
Duration in months
90
100 110 120
Source: 20th MDTR Report 2012, NRR
Table 13.8.3.3: Mean SBP, CsA vs Tacrolimus, 2004-2012
Mean SBP CsA
Mean SBP Tacrolimus
2004
132.7
128.7
2005
134.2
130.5
2006
131.4
127.6
2007
132.6
128
2008
130.6
125.2
2009
131.3
127.4
2010
130.2
128.1
2011
131.7
127.4
2012
131.4
129.2
Source: 20th MDTR Report 2012, NRR
Figure 13.8.3.3: Mean SBP, CsA vs Tacrolimus, 2004-2012
134
133
132
Mean SBP
131
130
129
128
127
126
125
124
'04
'05
'06
'07
CsA
'08
Year
'09
'10
'11
'12
Tacrolimus
Source: 20th MDTR Report 2012, NRR
Table 13.8.3.4: Mean GFR, CsA vs Tacrolimus, 2004-2012
Mean GFR CsA
Mean GFR Tacrolimus
2004
99.3
126.1
2005
97.3
111
2006
97.6
109.8
2007
96
104.4
2008
97.3
111
2009
95.6
108.8
2010
91.6
106.4
2011
90.7
101.9
2012
92.1
100.7
Source: 20th MDTR Report 2012, NRR
Figure 13.8.3.4: Mean GFR, CsA vs Tacrolimus, 2004-2012
130
Mean GFR
120
110
100
90
'04
'05
'06
'07
CsA
'08
Year
'09
'10
'11
'12
Tacrolimus
Source: 20th MDTR Report 2012, NRR
Table 13.8.3.5: Mean LDL, CsA vs Tacrolimus, 2004-2012
Mean LDL CsA
Mean LDL Tacrolimus
2004
3.2
3
2005
3
2.8
2006
3
2.9
2007
3
2.8
2008
2.9
2.8
2009
2.8
2.7
2010
2.9
2.8
2011
2.9
2.9
2012
2.9
2.8
Source: 20th MDTR Report 2012, NRR
Figure 13.8.3.5: Mean LDL, CsA vs Tacrolimus, 1993-2012
3.2
Mean LDL
3.1
3
2.9
2.8
'04
'05
'06
'07
CsA
'08
Year
'09
'10
'11
'12
Tacrolimus
Source: 20th MDTR Report 2012, NRR
Table 13.8.3.6: Incidence of post transplant diabetes mellitus, CsA vs
Tacrolimus, 2004-2012
Post Tx DM CsA
Post Tx DM Tacrolimus
2004
15
27
2005
15
25
2006
16
18
2007
13
15
2008
14
14
2009
10
9
2010
11
10
2011
11
9
2012
11
10
Source: 20th MDTR Report 2012, NRR
Figure 13.8.3.6: Cumulative incidence of post transplant diabetes, CsA
vs Tacrolimus, 2004-2012
0
2
4
6
8
10
12
14
Cumulative incidence of post transplant diabetes, CsA vs Tacrolimus, 2004-2012
2004
2005
2006
2007
Post Tx DM CsA
2008
Year
2009
2010
2011
2012
Post Tx DM Tacrolimus
Source: 20th MDTR Report 2012, NRR
Table 13.9.1: Cumulative distribution of QoL-Index score in relation to
dialysis modality, transplant recipient patients 1993-2012
Dialysis modality
Number of patients
QoL score
2227
Centile
0
0
0.05
9
0.1
10
0.25 (LQ)
10
0.5 (median)
10
0.75 (UQ)
10
0.9
10
0.95
10
1
10
Source: 20th MDTR Report 2012, NRR
Figure 13.9.1: Cumulative distribution of QoL-Index score in relation to
dialysis modality, transplant recipient patients 1993-2012
Cumulative distribution of QOL by Modality, Transplant Patients
1
.8
.6
.4
.2
0
0
1
2
3
4
5
6
QL-Index Score
7
8
9
10
Source: 20th MDTR Report 2012, NRR
Table 13.9.2: Cumulative distribution of QoL-Index score in relation to
diabetes mellitus, transplant recipient patients 1993-2012
Diabetes mellitus
No
Yes
1954
273
0
0
0
0.05
9
7
0.1
10
8
0.25 (LQ)
10
10
0.5 (median)
10
10
0.75 (UQ)
10
10
0.9
10
10
0.95
10
10
1
10
10
Number of patients
Centile
Source: 20th MDTR Report 2012, NRR
Figure 13.9.2: Cumulative distribution of QoL-Index score in relation to
diabetes mellitus, transplant recipient patients 1993-2012
Cumulative distribution of QOL by DM, Transplant Patients
1
.8
.6
.4
.2
0
0
1
2
3
4
5
6
QL-Index Score
No
7
8
9
10
Yes
Source: 20th MDTR Report 2012, NRR
Table 13.9.3: Cumulative distribution of QoL-Index score in relation to
gender, transplant recipient patients 1993-2012
Gender
Male
Female
Number of patients
1391
836
0
0
0
0.05
9
9
0.1
10
9
0.25 (LQ)
10
10
0.5 (median)
10
10
0.75 (UQ)
10
10
0.9
10
10
0.95
10
10
1
10
10
Centile
Source: 20th MDTR Report 2012, NRR
Figure 13.9.3: Cumulative distribution of QoL-Index score in relation to
gender, transplant recipient patients 1993-2012
Cumulative distribution of QOL by Gender, Transplant Patients
1
.8
.6
.4
.2
0
0
1
2
3
4
5
6
QL-Index Score
Male
7
8
9
10
Female
Source: 20th MDTR Report 2012, NRR
Table 13.9.4: Cumulative distribution of QoL-Index score in relation to
age, transplant recipient patients 1993-2012
Age group (years)
<20
20-39
40-59
>=60
Number of patients
218
944
954
111
0
0
0
0
0
0.05
9
9
8
7
0.1
10
10
9
8
0.25 (LQ)
10
10
10
9
0.5 (median)
10
10
10
10
0.75 (UQ)
10
10
10
10
0.9
10
10
10
10
0.95
10
10
10
10
1
10
10
10
10
Centile
Source: 20th MDTR Report 2012, NRR
Figure 13.9.4: Cumulative distribution of QoL-Index score in relation to
age, transplant recipient patients 1993-2012
Cumulative distribution of QoL-Index by Age Group, Transplant patients
1
.8
.6
.4
.2
0
0
1
2
3
4
5
6
QL-Index Score
Age <20
Age 40-59
7
8
9
10
Age 20-39
Age >=60
Source: 20th MDTR Report 2012, NRR
Table 13.9.5: Cumulative distribution of QoL-Index score in relation to
year of entry, transplant recipient patients 1993-2012
Source: 20th MDTR Report 2012, NRR
Figure 13.9.5: Cumulative distribution of QoL-Index score in relation to
year of entry, transplant recipient patients 1993-2012
Cumulative distribution of QOL by Year of Entry, Transplant Patients
1
.8
.6
.4
.2
0
0
1
2
3
Year 1993
Year 1999
Year 2005
Year 2011
4
5
6
QL-Index Score
Year 1995
Year 2001
Year 2007
7
8
9
10
Year 1997
Year 2003
Year 2009
Source: 20th MDTR Report 2012, NRR