Renal transplant surgery – Then and now

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.

Download Full-text

Robotic Versus Open Renal Transplantation in Obese Patients: Protocol for a Cost-Benefit Markov Model Analysis (Preprint)

10.2196/preprints.8294 ◽

2017 ◽

Author(s):

Michele Molinari ◽

Chethan Puttarajappa ◽

Martin Wijkstrom ◽

Armando Ganoza ◽

Roberto Lopez ◽

...

Keyword(s):

Sensitivity Analysis ◽

Renal Transplantation ◽

Renal Replacement Therapy ◽

Renal Transplant ◽

Markov Model ◽

Replacement Therapy ◽

Controlled Trial ◽

Cost Benefit ◽

Obese Patients ◽

Robotic Assisted

BACKGROUND Recent studies have reported a significant decrease in wound problems and hospital stay in obese patients undergoing renal transplantation by robotic-assisted minimally invasive techniques with no difference in graft function. OBJECTIVE Due to the lack of cost-benefit studies on the use of robotic-assisted renal transplantation versus open surgical procedure, the primary aim of our study is to develop a Markov model to analyze the cost-benefit of robotic surgery versus open traditional surgery in obese patients in need of a renal transplant. METHODS Electronic searches will be conducted to identify studies comparing open renal transplantation versus robotic-assisted renal transplantation. Costs associated with the two surgical techniques will incorporate the expenses of the resources used for the operations. A decision analysis model will be developed to simulate a randomized controlled trial comparing three interventional arms: (1) continuation of renal replacement therapy for patients who are considered non-suitable candidates for renal transplantation due to obesity, (2) transplant recipients undergoing open transplant surgery, and (3) transplant patients undergoing robotic-assisted renal transplantation. TreeAge Pro 2017 R1 TreeAge Software, Williamstown, MA, USA) will be used to create a Markov model and microsimulation will be used to compare costs and benefits for the two competing surgical interventions. RESULTS The model will simulate a randomized controlled trial of adult obese patients affected by end-stage renal disease undergoing renal transplantation. The absorbing state of the model will be patients' death from any cause. By choosing death as the absorbing state, we will be able simulate the population of renal transplant recipients from the day of their randomization to transplant surgery or continuation on renal replacement therapy to their death and perform sensitivity analysis around patients' age at the time of randomization to determine if age is a critical variable for cost-benefit analysis or cost-effectiveness analysis comparing renal replacement therapy, robotic-assisted surgery or open renal transplant surgery. After running the model, one of the three competing strategies will result as the most cost-beneficial or cost-effective under common circumstances. To assess the robustness of the results of the model, a multivariable probabilistic sensitivity analysis will be performed by modifying the mean values and confidence intervals of key parameters with the main intent of assessing if the winning strategy is sensitive to rigorous and plausible variations of those values. CONCLUSIONS After running the model, one of the three competing strategies will result as the most cost-beneficial or cost-effective under common circumstances. To assess the robustness of the results of the model, a multivariable probabilistic sensitivity analysis will be performed by modifying the mean values and confidence intervals of key parameters with the main intent of assessing if the winning strategy is sensitive to rigorous and plausible variations of those values.

Download Full-text

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

Proceedings of Singapore Healthcare ◽

10.1177/2010105820952095 ◽

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.

Download Full-text

Pregnancy after renal transplantation: Experience in singapore general hospital

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(00)80642-6 ◽

2000 ◽

Vol 70 ◽

pp. C96-C96

Author(s):

P.K. Tan ◽

V. Anantharaman ◽

A. Tan

Keyword(s):

Renal Transplantation ◽

General Hospital ◽

Singapore General Hospital

Download Full-text

Is There Decreasing Public Interest in Renal Transplantation? A Google TrendsTM Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9041048 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1048

Author(s):

Andreas Kronbichler ◽

Maria Effenberger ◽

Jae Il Shin ◽

Christian Koppelstätter ◽

Sara Denicolò ◽

...

Keyword(s):

Kidney Transplantation ◽

Renal Transplantation ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Public Interest ◽

Public Awareness ◽

Relative Reduction ◽

Special Focus ◽

Search Term ◽

Search Queries

Background and objectives: Renal transplantation is the preferred form of renal replacement therapy for the majority of patients with end stage renal disease (ESRD). The Internet is a key tool for people seeking healthcare-related information. This current work explored the interest in kidney transplantation based on Internet search queries using Google TrendsTM. Design, setting, participants, and measurements: We performed a Google TrendsTM search with the search term “kidney transplantation” between 2004 (year of inception) and 2018. We retrieved and analyzed data on the worldwide trend as well as data from the United Network for Organ Sharing (UNOS), the Organización Nacional de Trasplantes (ONT), the Eurotransplant area, and the National Health Service (NHS) Transplant Register. Google TrendsTM indices were investigated and compared to the numbers of performed kidney transplants, which were extracted from the respective official websites of UNOS, ONT, Eurotransplant, and the NHS. Results: During an investigational period of 15 years, there was a significant decrease of the worldwide Google TrendsTM index from 76.3 to 25.4, corresponding to an absolute reduction of −50.9% and a relative reduction by −66.7%. The trend was even more pronounced for the UNOS area (−75.2%), while in the same time period the number of transplanted kidneys in the UNOS area increased by 21.9%. Events of public interest had an impact on the search queries in the year of occurrence, as shown by an increase in the Google TrendsTM index by 39.2% in the year 2005 in Austria when a person of public interest received his second live donor kidney transplant. Conclusions: This study indicates a decreased public interest in kidney transplantation. There is a clear need to raise public awareness, since transplantation represents the best form of renal replacement therapy for patients with ESRD. Information should be provided on social media, with a special focus on readability and equitable access, as well as on web pages.

Download Full-text

Quality of Life and Health Status among those receiving Renal Replacement Therapy in Trinidad and Tobago. West Indies.

10.21203/rs.3.rs-19194/v1 ◽

2020 ◽

Author(s):

Sharlene Maria Sanchez ◽

Surujpal Teelucksingh ◽

Ronan Ali ◽

Henry Bailey ◽

George Legall

Keyword(s):

Quality Of Life ◽

Renal Replacement Therapy ◽

Renal Transplant ◽

Kidney Disease ◽

Trinidad And Tobago ◽

Replacement Therapy ◽

Health State ◽

Renal Transplant Recipients ◽

Transplant Recipients

Abstract Background A cross sectional study was conducted over a 1-year period in order to evaluate quality of life and health state for patients receiving renal replacement therapy in a resource constrained Caribbean island of Trinidad and Tobago. Methods Five hundred and thirty patients were enlisted in the study. For those who had received renal transplants (n=100) and for those on peritoneal dialysis (n=80), all were included. Among the 1000-odd patients who were receiving haemodialysis 350 were studied using convenience sampling. To be included, one had to be on renal replacement therapy for 3 months or more and at least 18 years of age. The Kidney Disease Quality of Life (KDQOL-36) and the EuroQol (EQ-5D-3L) instruments were administered after demographic data were collected. Transplant recipients were further evaluated with the Kidney Transplant Questionnaire (KTQ). Inferential analysis of data included 95% confidence intervals, hypothesis testing, multiple regression and analysis of variance. SPSS24, STATA14 and MINITAB18 were used. Results Of the 530 patients, 52.5% were male and 37.5% were in the 56-65 years age group. Hypertension (68.9%) and type 2 diabetes mellitus (50.5%) were reported as the main causes of kidney disease. The KDQOL-36 domain scores and significantly associated variables included modality of renal replacement (p=0.000), age (p=0.001), Charlson’s Comorbidity Index (p=0.001), income (p=0.000) and employment status (p=0.000). Transplant patients performed the best in the KDQOL-36. The mean visual analogue scale and index scores from the EQ-5D-3L were highest among renal transplant recipients (p=0.000). Conclusion Renal transplant recipients enjoy the best quality of life and health state among patients on renal replacement therapy in Trinidad and Tobago.

Download Full-text

Basic science and renal transplant

Oxford Handbook of Urology ◽

10.1093/med/9780198783480.003.0018 ◽

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.

Download Full-text

A path to renal transplantation in Nepal

Journal of Pathology of Nepal ◽

10.3126/jpn.v1i1.4453 ◽

1970 ◽

Vol 1 (1) ◽

pp. 52-55

Author(s):

J Enns ◽

G Aryal

Keyword(s):

Renal Transplantation ◽

Renal Replacement Therapy ◽

Human Leukocyte Antigen ◽

Replacement Therapy ◽

Human Leukocyte ◽

Cost Effective ◽

Leukocyte Antigen ◽

Post Transplant ◽

Stage Renal Disease ◽

End Stage

End Stage Renal Disease affects many people in the world. There are three methods of renal replacement therapy available to patients: Continuous ambulatory peritoneal dialysis, haemodialysis and transplantation. Transplantation is the most viable and cost effective form of renal replacement therapy that is available for these patients. There are 3 factors required to help ensure a successful renal transplantation program: A well legislated donor and recipient program, Human Leukocyte Antigen testing (pre and post transplant), as well as a post transplant follow up program. Keywords: Renal Transplant; South Asia; Nepal; Human Leukocyte Antigen DOI: 10.3126/jpn.v1i1.4453 Journal of Pathology of Nepal (2011) Vol.1, 52-55

Download Full-text