1. Table 5.1.1: Stock and Flow of Renal Transplantation, 1996-2005 Year1996199719981999200020012002200320042005 New transplant patients 151126104127143161168160187155 Died 31292325273531363738 Graft failure 28384836324038414415 Lost to follow up 10249279216 Functioning graft at 31st December 1023108211131175125013341426150015851681 Figure 5.1.1: Stock and Flow of Renal Transplantation, 1975-2005

2. Table 5.1.2: New transplant rate per million population (pmp), 1996-2005 Year1996199719981999200020012002200320042005 New transplant patients 151126104127143161168160187155 New transplant rate, pmp 7656677676 Figure 5.1.2: New transplant rate, 1996-2005 New Transplant rate, pmp Year 0 1 2 3 4 5 6 7 8 9 10 Rate, pmp 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05

3. Table 5.1.3: Transplant prevalence rate per million population (pmp), 1996-2005 Year1996199719981999200020012002200320042005 Functioning graft at 31st December 1023108211131175125013341426150015851678 Transplant prevalence rate, pmp 4850 52535658606669 Figure 5.1.3: Transplant prevalence rate, 1996-2005 Transplant Prevalence rate, pmp Year 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Rate, pmp 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05

4. Table 5.1.4: Place of transplantation, 1996-2005 Year199619971998199920002001 No.% % % % % % HKL3221292333323628 203320 UMMC756577161319132314 Selayang Hospital0000000043117 Other local000000113242 China1057079635048614880568251 India647677549674 Other overseas113233220011 Unknown002244650000 TOTAL 151100126100104100127100143100161100 Year2002200320042005TOTAL No.% % % % % HKL281726162011301929520 UMMC1486474641117 Selayang Hospital117 7 653534 Other local11112153171 China1026111169134721046790961 India1274311653735 Other overseas00112100131 Unknown00000000111 TOTAL 1681001601001871001551001482100

5. Table 5.2.1: Renal Transplant Recipients’ Characteristics, 1996-2005 Year1996199719981999200020012002200320042005 New Transplant Patients151126104127143161168160187155 Age at transplant (years), Mean393637 4041 424138 Age at transplant (years), SD11121113 14 % Male57635861646357666270 % Diabetic (co-morbid / primary renal disease)911910151915222119 % HBsAg positive13664547863 % Anti-HCV positive207181181591082

6. Table 5.2.2: Primary causes of end stage renal failure, 1996-2005 Year19961997199819992000 No.% % % % % New transplant patients151100126100104100127100143100 Glomerulonephritis48323024282741324934 Diabetes Mellitus1079755 81611 Hypertension854355761813 Obstructive uropathy2132444332 ADPKD4322111132 Drugs/toxic nephropathy0000000000 Hereditary nephritis0000000000 Unknown76506451555362495438 Others117181410 65128 Year20012002200320042005 No.% % % % % New transplant patients161100168100160100187100155100 Glomerulonephritis41255332543462334529 Diabetes Mellitus23141610261631172717 Hypertension17112414251650273724 Obstructive uropathy3221213221 ADPKD1132534232 Drugs/toxic nephropathy0000212100 Hereditary nephritis0000001100 Unknown61386840583682444730 Others221415912827141510

7. Table 5.3.1: Type of Renal Transplantation, 1996-2005 Year19961997199819992000 No.% % % % % Commercial Cadaver 106728066515262518056 Commercial Live Donor 4376444396 Live Donor (genetically related) 3624272227 40332115 Live Donor (emotionally related) 0000225464 Cadaver 218715 1082719 Total 1481001221009910012199143100 Year20012002200320042005 No.% % % % % Commercial Cadaver 825110261112701397610165 Commercial Live Donor 64117325385 Live Donor (genetically related) 32203018251621113523 Live Donor (emotionally related) 4232532132 Cadaver 3723221315917985 Total 161100168100160100184100155100 *Commercial Cadaver (China, India, other oversea) *Commercial live donor (living unrelated) *Cadaver (local)

8. Table 5.3.2: Biochemical data, 2004-2005 Biochemical parametersSummary20042005 Creatinine, umol/LN 15501633 Mean 132133.6 SD 63.865.5 Median 120 Minimum 3835 Maximum 817763 Hb, g/dLN 15501633 Mean 12.9 SD 1.9 Median 12.9 Minimum 4.95.5 Maximum 19.720.6 Albumin, g/LN 15501633 Mean 39.3 SD 10.5 Median 39.3 Minimum 2234 Maximum 5046 Calcium, mmol/LN 15501633 Mean 2.42.3 SD 0.2 Median 2.3 Minimum 1.11.2 Maximum 3.3 Biochemical parametersSummary20042005 Phosphate, mmol/LN15501633 Mean1.1 SD0.2 Median1.1 Minimum0.3 Maximum2.73.3 Alkaline Phosphatase (ALP), U/L N 15501633 Mean79.578.9 SD46.5 Median73 Minimum1018 Maximum994831 Alanine Transferase (ALT), U/L N 1550 1633 Mean 31.530.6 SD 32.629.8 Median 2524 Minimum 44 Maximum563613

9. Table 5.3.2: Biochemical data, 2004-2005 Biochemical parametersSummary 20042005 Total cholesterol, mmol/LN 15501633 Mean 5.55.4 SD 1.11 Median 5.4 Minimum 2.62.1 Maximum 2013.1 LDL cholesterol, mmol/LN 15501633 Mean 3.13 SD 0.70.8 Median 3.1 Minimum 10.9 Maximum 8.59.2 HDL cholesterol, mmol/LN 15501633 Mean 1.6 SD 0.40.5 Median 1.6 Minimum 0.2 Maximum 4.35.6 Biochemical parametersSummary 20042005 Systolic Blood Pressure, mmHg N 15501633 Mean132.3133.4 SD15.916.9 Median130 Minimum80 Maximum200220 Diastolic Blood Pressure, mmHg N 15501633 Mean80.380.6 SD9.69.2 Median80 Minimum4050 Maximum121127

10. Table 5.3.3: Medication data, 2004-2005 Medication dataSingle drug treatmentCombined drug treatment 2004200520042005 N%N%N%N% All patients 1416100155710014161001557100 (i) Immunosuppressive drug(s) treatment Prednisolone 131121139498152498 Azathioprine 00106034360539 Cyclosporin A 4040113580121978 Tacrolimus (FK506) 00001851322114 Mycophenolate Mofetil (MMF) 10005243767944 Rapamycin 00005081 Others 1000161101 (ii) Non-Immunosuppressive drug(s) treatment Beta blocker 104710576504666543 Calcium channel blocker 18813195137955682053 ACE inhibitor 3526042721934222 AIIRB 11119176515910 Anti-lipid 7356645664060039 Other anti-hypertensive 5050130915710

11. Table 5.4.1: Post transplant complications, 2004-2005 Post transplant complications Complication developed before transplant (regardless of complication after transplantation) Complication developed only after transplantation 2004200520042005 N%N%N%N% All patients 1550100163310015501001633100 Diabetes (either as Primary Renal Disease or co- morbid) 356233682312681238 Cancer 3020171191 Cardiovascular disease + cerebrovascular disorder 14791489835453 Hypertension 1003651042643972644027 * Hypertension: BP systolic > 140 and BP diastolic >90 OR have either Beta blocker / Calcium channel blocker / ACE inhibitor / AIIRB / Other anti-hypertensive

12. Table 5.4.2: Transplant Patients Death Rate and Graft Loss, 1996-2005 Year1996199719981999200020012002200320042005 No. at risk 978105310981144121312921380146315431633 Transplant death 31292325273531363738 Transplant death rate % 3322232222 Graft loss 28384836324038414415 Graft loss rate % 3443333331 Acute rejection 000000031814 Acute rejection rate % 0000000011 All losses 59677161597569809967 All losses rate % 6665565564 *Graft loss=graft failure *All losses=death / graft loss (acute rejection happens concurrently with graft failure/ death)

13. Figure 5.4.2(i): Transplant Recipient Death Rate, 1975-2005 Death rate percent Year 0 10 20 30 40 50 60 70 Annual death rate 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05

14. Figure 5.4.2(ii): Transplant Recipient Graft Loss Rate, 1975-2005 Graft loss rate percent Year 0 2 4 6 8 10 12 14 16 18 Annual graft loss rate 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05

15. Table 5.4.3: Causes of Death in Transplant Recipients, 1996-2005 Year1996199719981999200020012002200320042005 No% % % % % % % % % % Cardiovascular4133103134 103261551692337411 Died at home392741761913512516513615411 Infection185614489387231135194692910269221642 Graft failure00000000000000000000 Cancer26003133102661541361571725 Liver disease39272831013123 253738 Accidental death00000013131213000000 Others1341400516310252651392238 Unknown134143132626122625410616 TOTAL32100291002410031100311004110031100391004110038100

16. Table 5.4.4: Causes of Graft Failure, 1996-2005 Year1996199719981999200020012002200320042005 No.% % % % % % % % % % Rejection1450215427522364195925612255225033701878 Calcineurin toxicity00000000000000000000 Other drug toxicity00130000000000001200 Ureteric obstruction00000000000000000000 Infection00001200132500251214 Vascular causes144103613391200374929 Recurrent/de novo renal disease 27131200002525121200 Others005135100026004 120014 Unknown11397181529123372211271230153471514 TOTAL28100391005210036100321004110040100441004710023100

17. Table 5.4.5: Patient survival, 1993-2005 Interval (years)No.% SurvivalSE 11621951 31209921 5849891 10258811 * No.=Number at risk SE=standard error Figure 5.4.5: Patient survival, 1993-2005

18. Table 5.4.6: Graft survival, 1993-2005 Interval (years)No.% survivalSE 11616921 31208851 5848791 10257631 * No.=Number at risk SE=standard error Figure 5.4.6: Graft survival, 1993-2005

19. Table 5.4.7: Patient survival by type of transplant, 1993-2005 Type of TransplantCommercial CadaverCommercial Live DonorLive DonorCadaver Interval (years)No.% SurvivalSENo.% SurvivalSENo.% SurvivalSENo.% SurvivalSE 1 831961278961362961121841 3 56593123891129895188791 5 36389120087121994150751 10 54851125731748913691 * No.=Number at risk SE=standard error

20. Figure 5.4.7: Patient survival by type of transplant, 1993-2005 Cumulative survival Duration in years 024681012 0.00 0.25 0.50 0.75 1.00 Commercial cadaver Commercial live donor Live donor Cadaver

21. Table 5.4.8: Graft survival by type of transplant, 1993-2005 Type of TransplantCommercial CadaverCommercial Live DonorLive DonorCadaver Interval (years)No.% SurvivalSENo.% SurvivalSENo.% SurvivalSENo.% SurvivalSE 1 831941278931362911121751 3 56590123883129887188671 5 36383120074121982150641 10 54711125531747013371 * No.=Number at risk SE=standard error

22. Figure 5.4.8: Graft survival by type of transplant, 1993-2005 Cumulative survival Duration in years 024681012 0.00 0.25 0.50 0.75 1.00 Commercial cadaver Commercial live donor Live donor Cadaver

23. Table 5.4.9: Patient survival by year of transplant (Living related transplant, 1993-2005) Year of Transplant1993-19981999-2005 Interval (years)No.% SurvivalSENo.% SurvivalSE 1 181971182961 3 168951131941 5 15893162941 7 1469111941 * No.=Number at risk SE=standard error

24. Figure 5.4.9: Patient survival by year of transplant (Living related transplant, 1993-2005) Cumulative survival Duration in years 01234567 0.00 0.25 0.50 0.75 1.00 Year 1993- 1998 Year 1999- 2005

25. Table 5.4.10: Graft survival by year of transplant (Living related transplant, 1993-2005) Year of Transplant1993-19981999-2005 Interval (years)No.% SurvivalSENo.% SurvivalSE 1 181881182941 3 168831131901 5 15878162861 7 1467311811 * No.=Number at risk SE=standard error Figure 5.4.10: Graft survival by year of transplant (Living related transplant, 1993-2005) Cumulative survival Duration in years 01234567 0.00 0.25 0.50 0.75 1.00 Year 1993- 1998 Year 1999- 2005

26. Table 5.4.11: Patient survival by year of transplant (Commercial cadaver transplant, 1993-2005) Year of Transplant1993-19981999-2005 Interval (years)No.% SurvivalSENo.% SurvivalSE 1 288941544961 3 275921290931 5 248871115901 7 2268412-- * No.=Number at risk SE=standard error Figure 5.4.11: Patient survival by year of transplant (Commercial cadaver transplant, 1993-2005) Cumulative survival Duration in years 01234567 0.00 0.25 0.50 0.75 1.00 Year 1993- 1998 Year 1999- 2005

27. Table 5.4.12: Graft survival by year of transplant (Commercial cadaver transplant, 1993-2005) Year of Transplant1993-19981999-2005 Interval (years)No.% SurvivalSENo.% SurvivalSE 1 288931544951 3 275891290901 5 248801115851 7 2267412-- * No.=Number at risk SE=standard error Figure 5.4.12: Graft survival by year of transplant (Commercial cadaver transplant, 1993-2005) Cumulative survival Duration in years 01234567 0.00 0.25 0.50 0.75 1.00 Year 1993- 1998 Year 1999- 2005

28. Table 5.5.1: Risk factors for IHD in renal transplant recipients at year 2004 and 2005 20042005 Diabetes 28 (1.9)19 (1.2) Hypertension** 504 (34.3)513 (33.5) CKD 121 (8.2)142 (9.3) Diabetes + Hypertension**145 (9.9)157 (10.3) Diabetes + CKD21 (1.4)20 (1.3) CKD + Hypertension**530 (36.1)538 (35.2) Diabetes + CKD + Hypertension**120 (8.2)141 (9.2) ** Hypertension: BP systolic > 140 and BP diastolic >90 OR have either Beta blocker / Calcium channel blocker/ ACE inhibitor/ AIIRB / Other anti-hypertensive drugs GFR(mL/min/1.73m 2 ) = 1.2*(140-age(year))* weight(kg) / creatinine(µmol/L) if male GFR(mL/min/1.73m 2 ) = 0.85*(1.2*(140-age(year))* weight(kg) / creatinine(µmol/L) ) if female. CKD stage III – GFR, 30- 60 CKD stage IV – GFR, 15- 30 CKD stage V – GFR, < 15

29. Figure 5.5.1a: Venn Diagram for Pre and Post Transplant Complications (in %) at year 2004 8.2 9.9 1.436.1 1.9 8.2 34.3 Hypertension Diabetes

30. Figure 5.5.1b: Venn Diagram for Pre and Post Transplant Complications (in %) at year 2005 9.2 1.3 35.2 10.3 9.3 1.2 33.5 DiabetesHypertension

31. Table 5.5.2a: Systolic BP, 2004 – 2005 20042005 No. (%) Systolic BP <120207 (13.4)232 (14.2) Systolic BP <130341 (22.0)318 (19.5) Systolic BP 130-139459 (29.6)474 (29.0) Systolic BP 140-159418 (27.0)452 (27.7) Systolic BP 160-179102 (6.6)133 (8.1) Systolic BP >=18023 (1.5)24 (1.5)

32. Figure 5.5.2a: Systolic BP, 2004 and 2005 Percent Year 0 10 20 30 40 50 60 70 80 90 100 Systolic BP <120 Systolic BP <130 Systolic BP 130-139 Systolic BP 140-159 Systolic BP 160-179 Systolic BP >=180 20042005

33. Table 5.5.2b: Diastolic BP, 2004 and 2005 20042005 No. (%) Diastolic BP<80454 (29.3)465 (28.5) Diastolic BP<85661 (42.6)712 (43.6) Diastolic BP 85-8948 (3.1)73 (4.5) Diastolic BP 90-99319 (20.6)308 (18.9) Diastolic BP 100-10956 (3.6)65 (4.0) Diastolic BP >=11012 (0.8)10 (0.6)

34. Figure 5.5.2b: Diastolic BP, 2004 and 2005 Percent Year 0 10 20 30 40 50 60 70 80 90 100 Diastolic BP <80 Diastolic BP <85 Diastolic BP 85-89 Diastolic BP 90-99 Diastolic BP 100-109 Diastolic BP >=110 20042005

35. Table 5.5.3: CKD stages, 2004 - 2005 20042005 No. (%) CKD stage 1121 (7.9)118 (7.3) CKD stage 2570 (37.0)578 (35.6) CKD stage 3726 (47.1)798 (49.1) CKD stage 4110 (7.1)112 (6.9) CKD stage 513 (0.8)19 (1.2)

36. Figure 5.5.3: CKD stages by year Percent Year 0 10 20 30 40 50 60 70 80 90 100 CKD Stage 1 CKD Stage 2 CKD Stage 3 CKD Stage 4 CKD Stage 5 20042005

37. Table 5.5.4: BMI, 2004 – 2005 20042005 No. (%) BMI <20242 (15.6)253 (15.5) BMI 20-25610 (39.4)656 (40.2) BMI 25-30499 (32.2)512 (31.4) BMI > 30199 (12.8)212 (13.0) Figure 5.5.4: BMI by year Percent Year 0 10 20 30 40 50 60 70 80 90 100 BMI <20 BMI 20-25 BMI 25-30 BMI > 30 20042005

38. Table 5.5.5a: LDL, 2004 – 2005 20042005 No. (%) LDL < 2.6282 (18.2)418 (25.6) LDL 2.6-3.4944 (60.9)860 (52.7) LDL >= 3.4324 (20.9)355 (21.7) Figure 5.5.5a: LDL by year Percent Year 0 10 20 30 40 50 60 70 80 90 100 LDL <2.6 LDL 2.6-3.4 LDL >= 3.4 20042005

39. Table 5.5.5b: Total Cholesterol, 2004 - 2005 20042005 No. (%) Total Cholesterol <4.1113 (7.3)159 (9.7) Total Cholesterol 4.1-5.1413 (26.6)455 (27.9) Total Cholesterol 5.2-6.2751 (48.5)772 (47.3) Total Cholesterol 6.3- 7.2197 (12.7)173 (10.6) Total Cholesterol > 7.276 (4.9)74 (4.5) Figure 5.5.5b: Total Cholesterol by year Percent Year 0 10 20 30 40 50 60 70 80 90 100 Total Cholesterol <4.1 Total Cholesterol 4.1-5.1 Total Cholesterol 5.1-6.2 Total Cholesterol 6.2-7.2 Total Cholesterol > 7.2 20042005

40. Table 5.5.5c: HDL, 2004 - 2005 20042005 No. (%) HDL <187 (5.6)118 (7.2) HDL 1-1.3255 (16.5)308 (18.9) HDL >1.31208 (77.9)1207 (73.9) Figure 5.5.5c: HDL by year Percent Year 0 10 20 30 40 50 60 70 80 90 100 HDL <1 HDL, 1-1.3 HDL > 1.3 20042005

41. Table 5.5.6a: Treatment for hypertension, 2004 – 2005 YearNo.% on anti-hypertensives% on 1 anti-hypertensive drug% on 2 anti-hypertensives% on 3 anti-hypertensives 2004 155786293418 2005 162384283019 Table 5.5.6b: Distribution of Systolic BP without anti-hypertensives, 2004 – 2005 YearNo.MeanSDMedianLQUQ % Patients >= 160 mmHg 2004 181126.313.71301201304 2005 226126.715.41301201374 Table 5.5.6c: Distribution of Diastolic BP without anti-hypertensives, 2004 – 2005 YearNo.MeanSDMedianLQUQ % Patients >= 90 mmHg 2004 18178.99.180738017 2005 22679.311.580708018

42. Table 5.5.6d: Distribution of Systolic BP on anti-hypertensives, 2004 – 2005 YearNo.MeanSDMedianLQUQ % Patients >= 160 mmHg 2004 1311133.116.41301201409 2005 1338134.317.913012014311 Table 5.5.6e: Distribution of Diastolic BP on anti-hypertensives, 2004 – 2005 YearNo.MeanSDMedianLQUQ % Patients >= 90 mmHg 2004 131180.69.980749027 2005 133780.99.980769025