scholarly journals Renal transplantation at the Singapore General Hospital: a miracle in the making over 50 years

2020 ◽  
Vol 29 (4) ◽  
pp. 245-251
Author(s):  
Terence Kee Yi Shern
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
General Hospital ◽  
Organ Transplant ◽  
Kidney Donation ◽  
Kidney Donor ◽  
Human Organ ◽  
Singapore General Hospital ◽  
Donor Transplant

Background: This paper documents the history of the renal transplant programme at Singapore General Hospital. Renal transplantation in Singapore was born out of a necessity to offer a cheaper alternative to the expensive and scarce dialysis treatments in the 1970s. As a result, the first deceased kidney donor transplant was performed in 1970 at what Singapore General Hospital was then called ‘the Outram General Hospital’. However, deceased donation rates were dismal and prompted the start of a living kidney donor transplant programme in 1976 at Singapore General Hospital. Unfortunately, the prevalent population of patients with end-stage renal failure rapidly grew while kidney donation rates remain poor despite active efforts to raise awareness and even importing unwanted kidneys from other countries. Discussion: As a result, an opting-out legislation called the Human Organ Transplant Act was introduced in 1987 and increased the rate of deceased kidney donor transplantation in Singapore. Over the next two decades, access to kidney transplantation was further expanded with the introduction of living unrelated kidney donor transplantation and laparoscopic donor nephrectomy. In the past 10 years, there have been further advances in kidney transplantation with the introduction of newer immunosuppressive agents and technologies to perform incompatible kidney transplantation. The Human Organ Transplant Act has also been amended to allow the use of older deceased donors and permit paired kidney donor exchanges. Conclusion: Despite these many advances, kidney donation rates remain low and are even declining. This would certainly be the major challenge for the renal transplant programme in the next 50 years to come.

scholarly journals Renal transplant surgery – Then and now

2020 ◽  
Vol 29 (4) ◽  
pp. 252-255
Author(s):  
Valerie Huei Li Gan
Keyword(s):  
Renal Transplantation ◽  
Renal Replacement Therapy ◽  
Renal Transplant ◽  
Replacement Therapy ◽  
General Hospital ◽  
Transplant Program ◽  
Singapore General Hospital ◽  
Look Back ◽  
Kidney Transplantations

This year, Singapore General Hospital celebrates 50 years of renal transplantation. As we commemorate this historic milestone, we look back at the surgical journey and remember the pioneers, local as well as international, who have overcome myriad hurdles in performing kidney transplantations. These visionary surgeons have worked hand in hand with our nephrologists to establish renal transplantation as the renal replacement therapy of choice and our hospital as the oldest transplant program in Singapore.

scholarly journals Donor genetic variants in interleukin-6 and interleukin-6 receptor associate with biopsy-proven rejection following kidney transplantation.

2021 ◽  
Author(s):  
Felix Poppelaars ◽  
Mariana Gaya da Costa ◽  
Siawosh K. Eskandari ◽  
Jeffrey Damman ◽  
Marc A. Seelen
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Interleukin 6 ◽  
Medical Center ◽  
Organ Donors ◽  
Nucleotide Polymorphisms ◽  
Increased Risk ◽  
Major Player ◽  
The Impact

Rejection after kidney transplantation remains an important cause of allograft failure that markedly impacts morbidity. Cytokines are a major player in rejection, and we, therefore, explored the impact of interleukin-6 (IL6) and IL-6 receptor (IL6R) gene polymorphisms on the occurrence of rejection after renal transplantation. We performed an observational cohort study analyzing both donor and recipient DNA in 1,271 renal transplant-pairs from the University Medical Center Groningen in The Netherlands and associated single nucleotide polymorphisms (SNPs) with biopsy-proven rejection after kidney transplantation. The C-allele of the IL6R SNP (Asp358Ala: rs2228145 A>C, formerly rs8192284) in donor kidneys conferred a reduced risk of rejection following renal transplantation (HR 0.78 per C-allele; 95%-CI 0.67-0.90; P=0.001). On the other hand, the C-allele of the IL6 SNP (at position-174 in the promoter; rs1800795 G>C) in donor kidneys was associated with an increased risk of rejection for male organ donors (HR per C-allele 1.31; 95%-CI 1.08-1.58; P=0.0006), but not female organ donors (P=0.33). In contrast, neither the IL6 nor IL6R SNP in the recipient showed an association with renal transplant rejection. In conclusion, donor IL6 and IL6R genotypes but not recipient genotypes represent an independent prognostic marker for biopsy-proven renal allograft rejection.

Basic science and renal transplant

2019 ◽  
pp. 827-846
Author(s):  
John Reynard ◽  
Simon F Brewster ◽  
Suzanne Biers ◽  
Naomi Laura Neal
Keyword(s):  
Blood Flow ◽  
Renal Transplantation ◽  
Renal Replacement Therapy ◽  
Renal Transplant ◽  
Basic Science ◽  
Renal Physiology ◽  
Physiological Functions ◽  
Organ Rejection ◽  
Sodium And Potassium ◽  
Donor Transplant

This chapter covers the basic physiological functions of the kidney, bladder, and urethra. Renal anatomy is detailed, including the anatomical relations of the kidney. Renal physiology is covered in detail, including the regulation of renal blood flow and regulation of water, acid–base, sodium, and potassium balance. It includes the principles of renal replacement therapy and the principles of renal transplantation, including assessment of both the recipient and the donor. Transplant surgery is outlined, including commonly used drugs and complications and their management and common complications of renal transplant surgery. The different types of organ rejection are discussed, including their treatments.

scholarly journals Analysis of Factors Affecting Employment Status of Kidney Transplant Recipients in Selected European Union Member States

2021 ◽  
Vol 18 (19) ◽  
pp. 10284
Author(s):  
Elzbieta Wlodarczyk ◽  
Ondřej Viklický ◽  
Klemens Budde ◽  
Marie Kolářová ◽  
Leon Bergfeld ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Employment Status ◽  
Professional Activity ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Sf 36

Despite an increasing quality of life after renal transplantation, the number of recipients undertaking paid professional work remains relatively low. Employment after kidney transplantation became a new important marker of clinically significant health recovery. Furthermore, for social and economic reasons, returning to work and participation in social life may be considered as an objective parameter that demonstrate the effectiveness of transplantation. The objectives of the following study were to evaluate the factors that determine resuming paid work after renal transplantation, to assess a patient’s decision about returning to professional activity by comparative analysis of renal transplant recipients from Poland, Czech Republic and Germany, and to identify groups of patients exposed to professional exclusion in those EU countries. Five hundred renal transplant recipients from three EU countries were included into the study. The two main research methods used in the study were the SF-36 questionnaire, constructed and validated to assess the quality of life after kidney transplantation and a questionnaire constructed for the purposes of this study. Multifactorial analysis identified several risk factors associated with professional exclusions after kidney transplantation, namely young or advanced age, female gender, lack of education, place of residence in rural areas, long period of illness, and lack of occupational activity before transplantation. Despite the high standards of social care and rehabilitation support, patients in Germany failed to take up professional activity after kidney transplantation in more cases than those in Poland and Czech Republic. Surprisingly, the objective function of the kidney (creatinine level) and the multidimensional assessment of quality of life (SF-36 survey) did not have a significant association with the employment status after renal transplantation.

scholarly journals P1841THE JOURNEY OF KIDNEY TRANSPLANTATION IN EGYPT: STILL EXTRA-MILES TO GO

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mohamed Elrggal ◽  
Mohamed Gendia ◽  
Rowan Saad Zyada ◽  
Ali Moustafa Shendi Mohamed
Keyword(s):  
Kidney Transplantation ◽  
Organ Transplantation ◽  
Organ Transplant ◽  
Legal Framework ◽  
Organ Shortage ◽  
Organ Transplants ◽  
Organ Trafficking ◽  
Human Organ ◽  
Transplant Tourism ◽  
Transplant Program

Abstract Background and Aims Kidney transplantation is the renal replacement therapy of choice for patients with end-stage kidney disease. Egypt is a developing country with social, religious and demographic characteristics having enormous impact on the development and progress of its own national transplant program. Method A web-based review of relevant bibliography: articles and textbooks, reporting the progress in the transplant practice in Egypt and its legislations was conducted. Results Kidney transplantation started in Egypt about 43 years ago when the first transplant was performed at Mansoura Urology and Nephrology Center (UNC) in March 1976. The practice of kidney transplantation in Egypt has then evolved over the years. While about ten thousand transplants were performed from 1976 to 2011, the annual mean number of kidney transplantation between 2011 and 2016 increased to 1100 cases/year. The number of transplant centers has also grown from 12 in 1997 to 35 currently licensed centers. However, Egypt is still lacking a national transplant registry data. The legal framework developed over the last decade towards establishing a national transplant program. Until 2010, organ transplantation was only regulated by the professional code of ethics and conduct of the Egyptian Medical Syndicate. Representatives of the Istanbul Declaration met with the Egyptian Minister of Health and Egyptian Society of Nephrology leaders in Cairo in October 2008; since then, Egypt has been working to terminate illegal practices associated with organ transplantation, organ trafficking and transplant tourism. The first legislation for a national organ transplant program “The executive list for law number 5 of the year 2010 regarding regulating human organ transplants” was then issued after approval by the parliament. The law established “The Higher Committee for Organ Transplants” which includes 7 - 11 experts and is responsible for regulating and supervising all organ and tissue transplant procedures in the country. The new law criminalizes organ trafficking and set strict penalties for physicians, hospitals and medical facilities performing illegal organ transplant procedures. In 2017, the legislation has been further modified to make the penalties even harsher “Law number 142 of the year 2017 modification of some articles in law number 5 of the year 2010 regarding regulating human organ transplants”. Transplantation practice is still limited to live transplants. The cadaveric transplant program has not yet been put into action despite the new 2010 legislation has set the legal framework, yet lacking a clear definition of the legal death. Cadaveric transplantation was performed twice in Egypt in 1992 at Cairo (kasr El Aini hospital) from 2 criminals after execution in Alexandria. This was faced with social anger and rejection which led to legal restrictions for non-living organ procurement at that time. Barriers to establishment of a national transplant program in Egypt include cultural and religious rejection of deceased donation, organ shortage, and long waiting time in national transplant centers. Conclusion Despite the recent ameliorations in the current Egyptian transplant practice, the overall progress has been slow. This can be attributed to a complex interaction between social, religious and financial factors. Further advances are vital to reduce the burden implied by the state-funded dialysis therapy and to demolish organ trafficking and transplant tourism. As such, state efforts would continue to further improve the living donor and to implement the deceased donor transplantation programs.

scholarly journals Does the Presence of Renal Vascular Variation in the Renal Allograft Determine the Outcome of Renal Transplantation? Experience from the National Kidney Transplantation Center, Ethiopia

2021 ◽  
Author(s):  
Habtamu Wondmagegn ◽  
Abinet Gebremickael ◽  
Mahteme Bekele ◽  
Mala George ◽  
Teshale Fikadu ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Medical Records ◽  
Vascular Anatomy ◽  
Renal Allografts ◽  
Vascular Variations ◽  
Significant Difference ◽  
Transplantation Center ◽  
Renal Vascular

Abstract Background: Renal transplantation is the treatment of choice for people who suffer from end stage renal disease. Renal vascular anatomy is known for presenting a wide range of variations. Kidneys with variant renal vascular anatomy when used as a graft appear to be a potential risk factor that could impair the outcome of kidney transplantation. Information on renal vascular variations and its implication in the surgical outcome of renal transplantation has not been well studied. Hence, the present study was aimed to evaluate the outcomes of transplantation of renal allografts with variant renal vasculature as compared to allografts without renal vascular variation in the national kidney transplantation center of Ethiopia.Methods: A health institution based cross-sectional study was conducted. A retrospective review of the medical records of kidney recipients was performed. A total of 120 renal transplant recipient’s medical records were evaluated. Chi-square test and Independent t test was used to compare the surgical outcomes of renal transplantation. Graft survival was expressed using Kaplan-Meier curves, and was compared using the log-rank test. P values less than 0.05 was considered as statistically significant. Result: Evaluation of the renal transplant outcomes did not have shown a significant difference in the postoperative complication rate, rate of delayed graft function (DGF), creatinine clearance levels at 1 , 6, or 12 months postoperatively, and 1-year graft survival among recipients of allografts with and without renal vascular variations. However, operation time and the length of hospital stay were significantly longer among recipients of allografts with variant vasculature.Conclusion: No significant difference was noted in the outcomes of transplantation of renal allografts with and without vascular variations. Hence, renal allografts with vascular variations are safe to be recruited for transplantation as to this study.

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