Renal transplantation in Singapore

Area of Science:

• Nephrology
• Transplant Surgery
• Public Health Policy

Background:

• Renal transplantation is the optimal treatment for end-stage renal disease.
• Singapore has implemented legislative measures to address the demand-supply gap in kidney donation.
• This study assesses the impact of these policies on kidney transplant rates and outcomes.

Purpose of the Study:

• To evaluate the effectiveness of legislative measures in increasing kidney transplant rates in Singapore.
• To report on the graft and patient survival outcomes for kidney transplant recipients in Singapore.
• To compare Singapore's transplant rates and outcomes with international data.

Main Methods:

• Data on patient demographics, donor/recipient characteristics, and comorbidities were extracted from Singapore Renal Registry (SRR) Reports (1997-2006).
• Graft and patient survival rates were calculated using Kaplan-Meier analysis.
• Data were compared with published information from the United States Renal Data System (USRDS) and Organ Procurement and Transplantation Network (OPTN).

Main Results:

• The Human Organ Transplant Act significantly increased deceased donor kidney transplants post-1988.
• In 2006, local kidney transplant rates were 22.6 pmp (DD/LD) and 33.0 pmp (including overseas transplants).
• One and 5-year graft survivals were higher for living donors (98.1%/95.3%) versus deceased donors (88.9%/81.3%), with similar significant patient survival advantages.

Conclusions:

• Singapore's kidney transplant rates are lower than some Western countries but higher than other Asian nations.
• While 1-year outcomes align with international data, 5-year survivals are superior, potentially due to patient selection.
• Further efforts are needed to increase kidney transplant rates to meet patient demand in Singapore.