CHAPTER 13. Renal Transplanta on

Transcription

1 CHAPTER 13 Renal Transplanta on Rosnawa Yahya Hooi Lai Seong Ng Kok Peng Surya Bin Yakaob Wong Hin Seng

2 SECTION 13.1: STOCK AND FLOW The number of new transplant pa ents decreased from 151 in 26 to its lowest in 214 with only 91 transplant surgeries performed in 214. This substan al reduc on in the number of new transplants was predominantly due to reduc on in the number of transplanta on performed overseas. The number of new transplants improved by 14% with 14 transplants performed in 215. The number of func oning renal transplants had increased by 8% from 1774 in 26 to 1918 in 211 and declined from 211 onwards with 1845 func oning renal transplant in 215 (Table ). Despite advances in immunosuppression, the rate of allogra failure remained the same with 2-3% of allogra loss every year. Table : Stock and flow of renal transplanta on, New transplant pa ents Died Gra failure Lost to Follow up Func oning gra at 31 st December Figure : Stock and flow of renal transplanta on, New patients Functioning graft at 31st Dec 2, 1,8 1,6 No. of patients 1,4 1,2 1, The incidence rate of renal transplanta on declined from 6 per million popula on in 26 to 3 per million popula on in 213 and had remained sta c in the last three years (Table & Figure ). This is extremely low in comparison to Australia and New Zealand, which reported 37 and 27 per million popula on in 211. Table : New transplant rate per million popula on (pmp), New transplant pa ents New transplant rate, pmp

3 Table : Transplant prevalence rate per million popula on (pmp), Func oning gra at 31 st December Transplant prevalence rate, pmp The transplant prevalence rate con nue to drop over the last 1 years at 66 per million popula on in 26 to 61 per million popula on in 215 (Table & Figure ). Figure (a): New transplant rate, Rate, pmp Figure (b): Transplant prevalence rate, Rate, pmp New Transplant rate, pmp Transplant Prevalence rate, pmp Transplanta on in local centers increased with 51 transplants performed in 26, increasing to 85 transplants in 211. Unfortunately, this increase was not sustained and the number of renal transplants performed in local centers has remained sta c in 212 and 213. This is disturbing data as it underscores our failure to improve rate of transplanta on within the country, which is mainly due to the lack of both living as well as cadaveric donors. It is encouraging to see that the number of transplants performed in China con nued to drop from 87 cases (57.6%) in 26 down to 1 cases (1.1 %) in 213. Unfortunately, the figure rose to 14 cases (13.5%) in 215. It is worrying to see the number of transplants performed in other overseas centres increased with 8 cases reported in 215 (Table and Figure (a)). The number of transplants performed in Hospital Kuala Lumpur had remained sta c at 36 to 39 per year with a drop to 27 in 21 (Table and Figure (b)). 193

4 Figure (a): Places of transplanta on, Figure (b): Place of transplanta on within Malaysia Local Other overseas China Unknown India HKL PPUKM Prince Court UMMC Selayang Hospital Other local Number Table : Place of transplanta on, HKL PPUKM Prince Court Medical Centre UMMC Selayang Hospital Other local China India Other overseas Unknown Total HKL PPUKM Prince Court Medical Centre UMMC Selayang Hospital Other local China India Other overseas Unknown Total

5 SECTION 13.2: RECIPIENTS CHARACTERISTICS The number of new transplant pa ents decreased from 151 in 26 to its lowest in 214 with only 91 Over the last 1 years, the age of transplant recipients had remained unchanged, with a mean between 36 to 42 years old. Male pa ents con nued to predominate with 59 to 69% of the recipients. Over the last ten years, the propor on of diabe c pa ents who underwent renal transplanta on decreased slowly, 18% in 26 and only 12% in 215. This coincided with the drop in China transplants where the majority of the diabe c pa ents underwent their transplanta on. Pa ents with hepa s B had decreased from 7% earlier to -4% in the last 3 years. Pa ents with hepa s C showed ini al reduc on from 8-9% in 26 to 27, reduced to 1% in 212 and slowly increasing again to 5% in 215 In terms of underlying cause of end stage renal failure (Table ), the commonest cause was glomerulonephri s (GN), followed by hypertension and diabetes. The propor on of transplant recipients having end stage renal disease due to unknown causes had decreased from 44% in 26 to 19% in 215. Table : Renal transplant recipients characteris cs, New Transplant Pa ents Age at transplant (years), Mean Age at transplant (years), SD % Male % Diabe c (co-morbid/ primary renal disease) % HBsAg posi ve % An HCV posi ve Table : Primary causes of end stage renal failure, New transplant pa ents Glomerulonephri s Diabetes Mellitus Hypertension Obstruc ve uropathy ADPKD Drugs/ toxic nephropathy Hereditary nephri s 1 1 Unknown Others

6 Table : Primary causes of end stage renal failure, ( cont) New transplant pa ents Glomerulonephri s Diabetes Mellitus Hypertension Obstruc ve uropathy ADPKD Drugs/ toxic nephropathy Hereditary nephri s 2 2 Unknown Others SECTION 13.3: TRANSPLANT PRACTICES : Type of renal transplanta on The propor on of commercial transplanta on had gradually reduced significantly from 63.4% in 26 to 1.9% in 215. This was predominantly due to the marked decline in commercial cadaveric transplanta on (56.7% in 26 to 1.1% in 215). There was an increasing number of commercial living transplanta on from 6.7% in 26, peaked at 26.1% in 21 and declined to 9.8% in 215. Local cadaveric transplanta on made up 55.4% of transplants (51 recipients) in 215, which was the highest number seen in the last ten years. Local living donor transplanta on had shown an ini al rise from 29 transplants in 24, peaked at 63 transplants (67.3%) in 213. Unfortunately, this rise was not sustained and the number of local living donor transplants dropped to 33 (39.3%) recipients in 214 and 31 (33.7%) in 215. The year 27 marked the first me where there were more local transplants (55%) compared to overseas commercial transplants (45%). Since then, the propor on of local transplants con nued to rise with 92.5% of the total transplanta on performed locally in 213 and 89.1% in 215. Table : Type of renal transplanta on, Commercial cadaver donor Commercial live donor Live donor (gene cally related) Live donor (emo onally related) Cadaver donor Total Commercial cadaver donor Commercial live donor Live donor (gene cally related) Live donor (emo onally related) Cadaver donor Total *Commercial Cadaver (China, India, other oversea) *Commercial live donor (living unrelated) *Cadaver (local) 196

7 13.3.2: Biochemical data Table summarised the biochemical data for all the transplant recipients from 211 to 215. Biochemical parameter Summary Crea nine, umol/l n Mean SD Median Minimum Maximum Hb, g/dl n Mean SD Median Minimum Maximum Albumin, g/l n Mean SD Median Minimum Maximum Calcium, mmol/l n Mean SD Median Minimum Maximum Phosphate, mmol/l n Mean SD Median Minimum Maximum Alkaline phosphate (ALP), U/L n Mean SD Median Minimum Maximum ALT, U/L n Mean SD Median Minimum Maximum Total cholesterol, mmol/l n Mean SD Median Minimum Maximum

8 Table summarised the biochemical data for all the transplant recipients from 211 to 215. ( cont.) Biochemical parameter Summary LDL cholesterol, mmol/l n Mean SD Median Minimum Maximum HDL cholesterol, mmol/l n Mean SD Median Minimum Maximum Systolic blood pressure, mmhg n Mean SD Median Minimum Maximum Diastolic blood pressure, mmhg n Mean SD Median Minimum Maximum : Immunosuppression medica ons Majority of pa ents were on combina on immunosuppressions. Calcineurin-inhibitor based therapy remained the mainstay of immunosuppressive therapy with 48% of pa ents receiving it in 215. Cyclosporin was the most widely used calcineurin inhibitors un l 214. However, there was a gradual decline in cyclosporine usage with 55% in 211 to 41% in 215 which coincided with increasing use of tacrolimus, with 37% in 211 to 42% in 213 and 48% in 213. The usage of an prolifera ve agents have shown similar trend over the last 5 years. The used of azathioprine con nue to decline from 18% in 211 to 12% in 215. The use of mycophenolic acid fluctuated between 64 to 68% in the last 5 years. (Figure ) The use of prolifera on signal inhibitor (PSI) has increased from 4 % in 211 to 7% in

9 Table : Immunosuppressive Medica ons, Single drug treatment Medica on data All (i) Immunosuppressive drug(s) treatment Prednisolone Cyclosporin A Tacrolimus (FK56) Azathioprine MPA PSI 4 2 Others Medica on data Combined drug treatment All (i) Immunosuppressive drug(s) treatment Prednisolone Cyclosporin A Tacrolimus (FK56) Azathioprine MPA PSI Others : Non immunosuppression medica ons In terms of non-immunosuppressive medica ons, calcium channel blockers are the most commonly used an hypertensive as a single or combina on agent contribu ng to 64% of usage. This is followed by beta blockers with 42% of pa ents on it either alone or in combina on with other medica ons. The use of ACE inhibitors or angiotensin receptor blocker or both showed a slight increase over the last 5 years; 31% of pa ents were on ACE inhibitors or angiotensin II receptor blockers (AIIRB) or both in 211 and this increased to 42 % in 213 and 4% in

10 Table : Non immunosuppressive medica ons, Medica on data Single drug treatment All Non Immunosuppressive drug(s) treatment Alpha blocker Beta blocker Calcium channel blocker ACE inhibitor ARBs An lipid Other an hypertensive Medica on data Combined drug treatment All Non Immunosuppressive drug(s) treatment Alpha blocker Beta blocker Calcium channel blocker ACE inhibitor ARBs An lipid Other an hypertensive SECTION 13.4: TRANSPLANT OUTCOMES : Post transplant complica ons In the year 215, 53% of pa ents were hypertensive prior to transplanta on and 31% developed hypertension post transplanta on. In terms of cardiovascular and cerebrovascular disease, 2% had either or both prior to transplant and another 2% developed these complica ons post transplanta on. Cancer remains uncommon both before and a er transplanta on. About 13-14% of pa ents had diabetes pre transplant and another 6-8% of pa ents developed post transplant diabetes mellitus. 2

11 Table : Post transplant complica ons, Pre transplant All pa ents Diabetes (either as primary renal disease or comorbid) Cancer Cardiovascular disease + cerebrovascular disorder Hypertension Post transplant All pa ents Diabetes (either as primary renal disease or comorbid) Cancer Cardiovascular disease + cerebrovascular disorder Hypertension *Hypertension: BP systolic >14 and BP diastolic >9 or have either Beta blocker/ Calcium channel blocker / ACE inhibitor / ARBs/ Other an hypertensive : Deaths and gra loss In 215, 66 transplant recipients died and 54 lost their gra s. The annual rates of transplant death and gra s lost remained sta c at % and 2 3 % respec vely (Table ). The main causes of death had consistently been infec on and cardiovascular disease with 36% and 24% respec vely in 215. The propor on of pa ents died from infec on had remained sta c at 35-4%, which is a reflec on that the pa ents were heavily immunosuppressed. The propor on of pa ent who died at home, which was usually presumed to be cardiovascular death remained rela vely sta c (5%). Death due to cancers peaked in 213 contribu ng to 14% of all deaths. This had shown a decline to 6% in 214 and 215. Death due to liver disease slowly declined from 1% in 26 to around 3% in 215. Rejec on remained the major cause of gra loss (Table ). 21

12 Table : Transplant pa ent death rate and gra loss, Number at risk Transplant death Transplant death rate % Gra loss Gra loss rate % Acute rejec on Acute rejec on rate % All losses All losses rate % *Gra loss=gra failure *All losses=death / gra loss (acute rejec on happens concurrently with gra failure / death) Figure (a): Transplant recipient death rate, Death rate % Annual death rate Figure (b): Transplant recipient gra loss rate, Graft loss rate % Annual graft loss rate Table : Causes of death in transplant recipients, Cardiovascular Died at home Infec on Gra failure Cancer Liver disease Accidental death 1 2 Others Unknown Total

13 Cardiovascular Died at home Infec on Gra failure Cancer Liver disease Accidental death Others Unknown Total Table : Causes of gra failure, Rejec on Calcineurin toxicity Other drug toxicity Ureteric obstruc on Infec on Vascular causes Recurrent/ de novo renal disease Chronic allogra nephropathy / IFTA Technical problem Others Unknown Total Rejec on Calcineurin toxicity Other drug toxicity Ureteric obstruc on 1 2 Infec on Vascular causes Recurrent/ de novo renal disease Chronic allogra nephropathy / IFTA Technical problem 1 2 Others Unknown Total

14 SECTION 13.5: PATIENT AND GRAFT SURVIVAL : Pa ent survival Overall pa ent survival rates from 26 to 215 were 96%, 94%, 9% and 75% at year 1, 3, 5 and 1 respec vely. Factors affec ng pa ent survival were years of transplanta on, age at transplanta on, primary disease and type of transplanta on. Pa ents who underwent renal transplanta on in later years (between 211 to 215) have lower risk of mortality in comparison to those who were transplanted between This may reflect be er recipient selec on and prepara on as well as improvement in management in the post transplant period. Older pa ents were also at higher risk of mortality. Table (a): Pa ent survival, Figure (a): Pa ent survival, Interval (years) *n=number at risk SE=standard error n % Survival SE Cumulative survival Transplant patient survival, Duration in years 24

15 Table (b): Risk factors for transplant pa ent survival Factors n Hazard Ra o 95% CI P value of transplant (ref*) (.173,.952).38 Age at transplant <2 na na na 2-39 (ref*) (1.67, 3.272).29 >= (.466, 5.823).438 Gender Male (ref*) Female (.474, 1.442).53 Primary diagnosis Unknown primary (ref*) Diabetes mellitus (.14, 2.186).341 GN/SLE (.342, 1.617).454 Polycys c kidney (.89, 5.449).732 Obstruc ve nephropathy (.915, 9.131).7 Others (.828, 3.73).163 Type of transplant Commercial cadaver (ref*) Commercial live donor (.433, 2.413).959 Living donor (.377, 1.569).471 Cadaver (1.178, 4.182).14 HBsAg Nega ve (ref*) Posi ve na na na An HCV Nega ve (ref*) Posi ve na na na 25

16 13.5.2: Gra survival Overall gra survival rates were 92%, 88%, 82% and 62% at year 1, 3, 5 and 1 respec vely. (Table and Figure a & a). Table (a): Gra survival, Figure (a): Gra survival, Interval (years) n % Survival SE Cumulative survival Transplant graft survival, Duration in years *n=number at risk SE=standard error 26

17 Table (b): Risk factors for transplant gra survival Factors n Hazard Ra o 95% CI P value of transplant (ref*) (.173,.952).38 Age at transplant <2 na na na 2-39 (ref*) (1.67, 3.272).29 >= (.466, 5.823).438 Gender Male (ref*) Female (.474, 1.442).53 Primary diagnosis Unknown primary (ref*) Diabetes mellitus (.14, 2.186).341 GN/SLE (.342, 1.617).454 Polycys c kidney (.89, 5.449).732 Obstruc ve nephropathy (.915, 9.131).7 Others (.828, 3.73).163 Type of transplant Commercial cadaver (ref*) Commercial live donor (.433, 2.413).959 Living donor (.377, 1.569).471 Cadaver (1.178, 4.182).14 HBsAg Nega ve (ref*) Posi ve na na na An HCV Nega ve (ref*) Posi ve na na na 27

18 13.5.3: Pa ent survival according to type of transplant Outcomes of renal transplanta on over the last 1 years in 4 different donor groups are shown in Table and Figures For local living renal transplanta on, the 1, 3 and 5-year pa ent survival was 98%, 96% and 95% respec vely. The pa ent survival of commercial cadaveric transplanta on was 96%, 93%, 89% and 75% at year 1, 3, 5 and 1 respec vely. The pa ent survival of local cadaveric allogra recipients was worse in comparison to all other groups. This may be due to older age group, longer dialysis vintage and more comorbidity in this group. The pa ent survival of commercial live donor transplant is comparable to that of local live donor transplant. Table : Unadjusted pa ent survival by type of transplant, Type of Transplant Commercial Cadaver Donor Commercial Live Donor Live Donor Cadaver Donor Interval (years) n % Survival SE n % Survival SE n % Survival SE n % Survival SE *n=number at risk SE=standard error Figure : Pa ent survival by type of transplant, Figure : Gra survival by type of transplants, Transplant patient survival by Type of Transplant, Transplant graft survival by Type of Transplant, Live donor.8 Commercial live donor Commercial cadaver.8 Commercial live donor Cumulative survival.6.4 Cadaver Cumulative survival.6.4 Commercial cadaver Live donor Cadaver Duration in years Duration in years 28

19 13.5.4: Gra survival according to type of transplant For local living renal transplanta on, the gra survival was 94%, 92% and 87% at year 1, 3 and 5 respecvely. The gra survival for commercial cadaveric transplant was 94%, 91%, 85% and 68% at year 1, 3, 5 and 1 respec vely. This is comparable to gra survival of local living transplanta on. The gra survival of local cadaveric allogra recipients was worse in comparison to all other groups with only 69% and 33% gra surviving at 5 and 1 years respec vely. Table : Gra survival by type of transplant, Type of Commercial Commercial Transplant Cadaver Donor Live Donor Live Donor Cadaver Donor Interval (years) n % Survival SE n % Survival SE n % Survival SE n % Survival SE *n=number at risk SE=standard error : Outcome of living related renal transplanta on Pa ent and gra survival for living related transplants were compared between two cohorts, those transplanted between and In living related transplants, pa ent survival appears to be be er in those transplanted in the la er period. However, gra survival between these 2 cohorts was similar (Table and Figure a & b). Table (a): Pa ent survival by year of transplant (Living related transplant, ) of Transplant Interval (years) n % Survival SE n % Survival SE *n=number at risk SE=standard error 29

20 Figure (a): Pa ent survival by year of transplant (Living related transplant, ) Figure (b): Gra survival by year of transplant (Living related transplant, ) 1. Transplant patient survival by of Transplant, Transplant graft survival by of Transplant, Cumulative survival.6.4 Cumulative survival Duration in years Duration in years Table (b): Gra survival by year of transplant (Living related transplant, ) of Transplant Interval (years) n % Survival SE n % Survival SE *n=number at risk SE=standard error : Outcome of commercial cadaveric transplanta on Pa ent and gra survival for commercial cadaveric transplants were compared between two cohorts, those transplanted between and Pa ent survival appeared to be be er for the later cohort However, gra survival between these 2 cohorts was similar (Table & Figure (a) & (b)). 21 Table (a): Pa ent survival by year of transplant (Commercial cadaver transplant, ) of Transplant Interval (years) n % Survival SE n % Survival SE *n=number at risk SE=standard error

21 Figure (a): Pa ent survival by year of transplant (Commercial cadaver transplant, ) 1. Transplant patient survival by of Transplant, Figure (b): Gra survival by year of transplant (Commercial cadaver transplant, ) Transplant graft survival by of Transplant, Cumulative survival Cumulative survival Duration in years Duration in years Table (b): Gra survival by year of transplant (commercial cadaver transplant, ) of Transplant Interval (years) n % Survival SE n % Survival SE *n=number at risk SE=standard error 211

22 SECTION 13.6: CARDIOVASCULAR RISK IN RENAL TRANSPLANT RECIPIENTS : Risk factors for ischaemic heart disease (IHD) In 215, 86.8% of pa ents were hypertensive, 21.4% were diabe c and 48.1% had renal insufficiency fulfilling CKD III and above. Thirty-seven percent of pa ents had 2 cardiovascular risk factors while 12.8% had all 3 major risk factors. The propor on of pa ents with hypertension appeared to be decreasing over the years. The propor on of pa ents with diabetes remained the same. Table : Risk factors for IHD in renal transplant recipients at year Diabetes 25 (1.5) 26 (1.6) 33 (2.) 27 (1.6) 24 (1.5) Hypertension** 69 (4.7) 594 (37.1) 637 (38.5) 655 (39.9) 661 (4.3) CKD 132 (7.8) 167 (1.4) 149 (9.) 123 (7.5) 147 (9.) Diabetes + Hypertension** 96 (5.7) 98 (6.1) 96 (5.8) 111 (6.8) 116 (7.1) Diabetes + CKD 44 (2.6) 41 (2.6) 4 (2.4) 36 (2.2) 46 (2.8) CKD + Hypertension** 482 (28.4) 465 (29.) 52 (3.4) 483 (29.4) 436 (26.6) Diabetes + CKD + Hypertension** 226 (13.3) 21 (13.1) 196 (11.9) 26 (12.6) 29 (12.8) **Hypertension: BP systolic > 14 and BP diastolic > 9 OR have either Beta blocker / Calcium channel blocker / ACE inhibitor / AIIRB / Other an hypertensive drugs GFR (ml/min/1.73m2) = 1.2*(14-age(year))*weight(kg) / crea nine (µmol/l) if male GFR (ml/min/1.73m2) =.85*(1.2*(14-age(year))*weight(kg) / crea nine (µmol/l) if female CKD stage III-GFR, 3-6 CKD stage IV-GFR, 15-3 CKD stage V-GFR, <15 Figure (a): Venn diagram for pre and post transplant complica ons (in %) at year 211 Figure (b): Venn diagram for pre and post transplant complica ons (in %) at year

23 Figure (c): Venn diagram for pre and post transplant complica ons (in %) at year 213 Figure (d): Venn diagram for pre and post transplant complica ons (in %) at year 214 Figure (e): Venn diagram for pre and post transplant complica ons (in %) at year

24 13.6.2: Blood Pressure classifica on according to JNC VI criteria, In 215, twenty-four percent of renal transplant recipients had stage I systolic hypertension and 4% had stage II hypertension despite being on treatment (Table (a)). Ten percent of pa ents had stage I diastolic hypertension. Table (a): Systolic BP, < >= Figure (a): Systolic BP, Systolic BP <12 Systolic BP Systolic BP Systolic BP Systolic BP Systolic BP >= Percent Table (b): Diastolic BP, < >=

25 Figure (b): Diastolic BP, Diastolic BP <8 Diastolic BP 8-85 Diastolic BP Diastolic BP 9-99 Diastolic BP 1-19 Diastolic BP >= Percent : Level of allogra func on Table and Figure summarises the CKD Stage classifica on. In 215, 4% of renal transplant recipients had CKD Stage III, whilst another 8% had CKD Stage IV. CKD Stage V (impending renal replacement therapy) was found in 2% of renal transplant recipients. Table : CKD stages, Stage Stage Stage Stage Stage Figure : CKD stages by year 1 CKD Stage 1 CKD Stage 2 CKD Stage 3 CKD Stage 4 CKD Stage 5 8 Percent

26 13.6.4: Body mass index In 215, 56% percent of renal transplant recipients had BMI of 25 or below. However, 29% were overweight and another 14% were obese. Table : BMI, < > Figure : BMI, BMI <2 BMI 2-25 BMI 25-3 BMI > 3 8 Percent : LDL cholesterol LDL cholesterol had been iden fied as the primary lipid target for preven on of coronary heart disease by Na onal Cholesterol Educa on Program (NCEP) with a log linear rela onship between risk of coronary heart disease and level of LDL cholesterol. In 215, 44% of our renal transplant recipients had LDL levels below 2.6 mmol/l. It is encouraging to observe the LDL level in transplant pa ents con nue to improve in the last five years. Whether or not this translated into less cardiovascular mortality in the transplant popula on is s ll ques onable. Propor on of pa ents with serum LDL >3.4 mmol/l remained rela vely sta c throughout the last five-year period. In terms of other cholesterol parameters, 55% had total cholesterol levels <5.1 mmol/l and 8% had HDL cholesterol levels <1. mmol/l. Table (a): LDL, < 2.6 mmol/l mmol/l >= 3.4 mmol/l

27 Figure (a): LDL, LDL <2.6 LDL LDL >= Percent Table (b): Total cholesterol, <4.1 mmol/l mmol/l mmol/l mmol/l > 7.2 mmol/l Figure (b): Total cholesterol, Total Cholesterol <4.1 Total Cholesterol Total Cholesterol Total Cholesterol Total Cholesterol > Percent Table (c): HDL, <1 mmol/l mmol/l >1.3 mmol/l

28 Figure (c): HDL, HDL <1 HDL HDL > Percent : Blood pressure control There was no change in the percentage of pa ents who were on an hypertensives over the last fiveyear period with 7 to 76% were on an hypertensive medica ons. Furthermore, the percentage of pa ents taking mul ple an hypertensive medica ons had not changed much with 38% taking one an hypertensive, 26% taking two an hypertensives and 7% taking 3 an hypertensives. The systolic blood pressure appears to be increasing over the last 5 years, whereas diastolic BP had remained rela vely the same. In 215, 4% of pa ents s ll had systolic BP of >16 mmhg and 1% had diastolic BP of > 9 mmhg despite being given an hypertensive(s). Table (a): Treatment for hypertension, n % on an hypertensives % on 1 an hypertensive drug % on 2 an hypertensives % on 3 an hypertensives Table (b): Distribu on of systolic BP without an hypertensives, n Mean SD Median % Pa ents 16mmHg LQ UQ 218

29 Table (c): Distribu on of diastolic BP without an hypertensives, n Mean SD Median LQ UQ % pa ents 9mmHg Table (d): Distribu on of systolic BP on an hypertensives, n Mean SD Median LQ UQ % Pa ents 16mmHg Table (e): Distribu on of diastolic BP on an hypertensives, n Mean SD Median % Pa ents 9 mmhg LQ UQ SECTION 13.7: QOL INDEX SCORE IN RENAL TRANSPLANT RECIPIENTS Eight hundred sixty three pa ents who were transplanted from were analysed for QoL index score. They reported median QoL index score of 1 (Table & Figure ). There was no difference in the median QoL index score between diabe cs and non-diabe cs who underwent renal transplanta on during this period (Table & Figure ). There was also no difference seen between gender (Table & Figure ) and age (Table & Figure ). It is worthwhile to note that those above 6 years old also enjoyed the same QoL index score (1) as their younger counterparts (Table & Figure ). This trend of high QoL index score remained the same for the last ten years. 219

30 Table : Cumula ve distribu on of QoL- Index score in rela on to dialysis modality, transplant recipient pa ents Table : Cumula ve distribu on of QoL- Index score in rela on to diabetes mellitus, transplant recipient pa ents Dialysis modality QoL score Number of pa ents 863 Cen le (LQ) 1.5 (median) 1.75 (UQ) Diabetes mellitus No Number of pa ents 76 Cen le (LQ) 1.5 (median) 1.75 (UQ) Yes Figure : Cumula ve distribu on of QoL- Index score in rela on to dialysis modality, transplant recipient pa ents Cumulative distribution of QOL by Modality, Transplant Patients Figure : Cumula ve distribu on of QoL- Index score in rela on to diabetes mellitus, transplant recipient pa ents Cumulative distribution of QOL by DM, Transplant Patients 1 Cumulative Distribution Cumulative Distribution QL-Index Score QL-Index Score No Yes 22

31 Table : Cumula ve distribu on of QoL- Index score in rela on to gender, transplant recipient pa ents Figure : Cumula ve distribu on of QoL- Index score in rela on to gender, transplant recipient pa ents Gender Male Female 1 Cumulative distribution of QOL by Gender, Transplant Patients Number of pa ents 592 Cen le (LQ) Cumulative Distribution (median) 1.75 (UQ) QL-Index Score Male Female Table : Cumula ve distribu on of QoL-Index score in rela on to age, transplant recipient pa ents Age group (years) <2 Number of pa ents Cen le (LQ) -.5 (median) -.75 (UQ) >=

32 Figure : Cumula ve distribu on of QoL- Index score in rela on to age, transplant recipient pa ents Cumulative distribution of QoL-Index by Age Group, Transplant patients Figure : Cumula ve distribu on of QoL- Index score in rela on to year of entry, transplant recipient pa ents Cumulative distribution of QOL by of Entry, Transplant Patients Cumulative Distribution Cumulative Distribution QL-Index Score Age <2 Age 2-39 Age 4-59 Age >= QL-Index Score Table : Cumula ve distribu on of QoL-Index score in rela on to year of entry, transplant recipient pa ents of Entry Number of pa ents Cen le (LQ) (median) (UQ)