Nineteen-year experience of paediatric renal transplantation in Singapore.
- Author:
Kar Hui NG
1
;
Pramod SHRESTHA
;
Eric ARAGON
;
Yew Weng LAU
;
Wee Song YEO
;
Yiong Huak CHAN
;
Prabhakaran KRISHNAN
;
Hui Kim YAP
Author Information
- Publication Type:Journal Article
- MeSH: Adolescent; Child; Child, Preschool; Female; Graft Survival; Humans; Kidney Failure, Chronic; surgery; Kidney Transplantation; utilization; Living Donors; supply & distribution; Male; Multivariate Analysis; Outcome Assessment (Health Care); trends; Postoperative Complications; epidemiology; Singapore; epidemiology; Survival Analysis; Young Adult
- From:Annals of the Academy of Medicine, Singapore 2009;38(4):300-309
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTIONRenal transplantation is the treatment of choice for children with end-stage renal failure (ESRF). The paediatric renal transplant programme in Singapore was initiated in 1989. This study aimed to examine our outcomes over the 19-year period from 1989 to 2007.
MATERIALS AND METHODSA total of 38 renal transplants were performed at our centre. Another 4 patients with overseas transplants who returned within 3 weeks post-transplant were included. The proportion of living donor (LD) transplants was 61.9%. Structural abnormalities and glomerulopathies were the most common aetiologies comprising 33% each. Median age at transplant was 13.9 years and median waiting time was 2.2 years. LD transplant recipients were younger and had a shorter waiting time than deceased donor (DD) recipients.
RESULTSOverall patient survival rates were 95%, 92%, 86% and 86% at 1, 5, 10 and 15 years, respectively. There were 4 deaths, of which 3 were due to infections. Graft survival rates at 1, 5, 10 and 15 years for LD and DD transplants were 100%, 89.5%, 67.3%, 67.3% and 80.8%, 56.5%, 42.2%, 28.3% respectively, and were significantly higher in LD transplants. The main cause of graft loss was rejection following non-adherence. Multivariate analysis showed male gender, late acute rejections and acute tubular necrosis as predictors of graft failure. There was a high incidence of early bacterial infections (42.9%) and cytomegalovirus disease (16.7%).
CONCLUSIONOur graft survival rates for LD transplants were comparable to North American rates, although our DD transplant rates were slightly worse, probably a reflection of the prevailing transplant policies.