Vathsala A, Chow Khuan Yew
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Ann Acad Med Singap. 2009 Apr;38(4):291-9.
Renal transplantation is the best treatment for kidney failure. As the demand far exceeds the supply, various legislative measures have been put into place in Singapore to increase kidney transplant rates. This paper evaluates the impact of these measures and reports on the outcomes for kidney transplant recipients in Singapore.
Patient demographics, recipient and donor characteristics, and co-morbidities occurring in incident transplant patients were extracted from Singapore Renal Registry (SRR) Reports from 1997 to 2006, tabulated and summarised. Graft and patient survivals data, which were calculated by Kaplan-Meier analysis until return to dialysis/pre-emptive renal re-transplant or patient death respectively, were extracted from SRR Reports. Published data from the United States Renal Data System (USRDS) and Organ Procurement and Transplantation Network (OPTN) were used for comparisons with data from the SRR.
The introduction of the Human Organ Transplant Act increased the rate of deceased donor (DD) kidney transplants from 4.7 per year from 1970 to 1988, to 41.4 per year from 1988 to 2004. In 2006, the overall DD and living donor (LD) rate for kidney transplants performed locally for Singaporeans and permanent residents of Singapore was 22.6 per million population (pmp); taking into account overseas kidney transplants, the kidney transplant rate was 33.0 pmp. One and 5-year graft survivals for local LD and DD transplanted between 1999 and 2006, as reported by the SRR, were 98.1% and 95.3% versus 88.9% and 81.3%, respectively (P <0.001). Patient survivals at 1 and 5 years were likewise significantly better for LD versus DD (99.4% and 96.6% vs. 96% and 89.1%, respectively; P = 0.005).
The local kidney transplant rates were lower than those reported by the USRDS for the USA, Spain, Norway and Australia but higher than other Asian countries. While 1-year outcomes for transplants reported to the SRR were similar to that reported by the OPTN, 5-year survivals were significantly higher, possibly due to the selection of patients with fewer comorbidities for kidney transplantation in Singapore. These results suggest that while outcomes are excellent, there is much more to be done to increase kidney transplantation rates in Singapore so as to meet the needs of end-stage renal failure patients in the country.
肾移植是治疗肾衰竭的最佳方法。由于需求远远超过供给，新加坡已采取各种立法措施以提高肾移植率。本文评估了这些措施的影响，并报告了新加坡肾移植受者的治疗结果。
从1997年至2006年的新加坡肾脏登记处（SRR）报告中提取了首次移植患者的人口统计学数据、受者和供者特征以及所出现的合并症，制成表格并进行总结。移植肾和患者的生存数据通过Kaplan-Meier分析计算得出，分别直至恢复透析/抢先肾再移植或患者死亡，这些数据从SRR报告中提取。美国肾脏数据系统（USRDS）和器官获取与移植网络（OPTN）发布的数据用于与SRR的数据进行比较。
《人体器官移植法》的实施使尸体供肾（DD）移植率从1970年至1988年的每年4.7例，提高到1988年至2004年的每年41.4例。2006年，新加坡人和新加坡永久居民在当地进行的肾移植中，总体DD和活体供肾（LD）率为每百万人口22.6例（pmp）；考虑到海外肾移植，肾移植率为33.0 pmp。根据SRR报告，1999年至2006年期间当地LD和DD移植的1年和5年移植肾存活率分别为98.1%和95.3%，而DD移植分别为88.9%和81.3%（P<0.001）。LD移植的1年和5年患者存活率同样显著高于DD移植（分别为99.4%和96.6%，而DD移植分别为96%和89.1%；P = 0.005）。
新加坡当地的肾移植率低于美国、西班牙、挪威和澳大利亚的USRDS报告的比率，但高于其他亚洲国家。虽然向SRR报告的移植1年结果与OPTN报告的相似，但5年存活率显著更高，这可能是由于新加坡选择合并症较少的患者进行肾移植。这些结果表明，尽管治疗效果良好，但新加坡仍有许多工作要做，以提高肾移植率，满足该国终末期肾衰竭患者的需求。
