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Dr Rosnawati Yahya

Dr Rosnawati Yahya

Dr Rosnawati Yahya

Designation

Head of Transplantation Unit Department of Nephrology Hospital Kuala Lumpur

Institution

Hospital Kuala Lumpur

Qualification

B.Sc(Med Sci) MBChB(Hons) MRCP(UK)

Special field of interest

Kidney Transplantation Glomerular Diseases

Abstract

Title: Overview of Kidney Transplantation in Malaysia
Body: Introduction In Malaysia, more than 44,000 people live with end-stage kidney disease (ESKD) (1). The development of chronic kidney disease (CKD) and its progression to this terminal disease remains a significant source of reduced quality of life and significant premature mortality. Chronic kidney disease (CKD) is a debilitating disease, and standards of medical care involve monitoring and managing risk factors of disease progression. Early referral to nephrologists for planning of kidney replacement therapy is important. Options of kidney replacement therapy include kidney transplantation, haemodialysis and peritoneal dialysis. In some patients a conservative approach may be considered if dialysis is not suitable or in patients with limited life expectancy due to other co-morbidities. Burden of CKD & status of kidney transplantation The prevalence of CKD in Malaysia had increased from 9.1% in 2011 to 15.5% in 2018(2). Similarly, the number of treated ESKD had increased from 26,442 in 2011 to 44.136 in 2018(1). Bujang and his co-worker predicted that the prevalence of ESKD will continue to rise from 46 thousands patients in 2018 to 100 thousand patients by 2040 (3). The rise in the prevalence of ESKD has a significant impact the economy of Malaysia. Based on Hirman et al, The ESKD expenditure in public sectors had increased by 94% from USD 405 million in 2010 to USD 785 million in 2016 (4). Unfortunately, the number of kidney transplantation performed in Malaysia is extremely low. In 2020, Malaysia observe incidence rate of living kidney transplant rate of 3.46 pmp and deceased kidney transplant rate of 1.27 pmp with a total kidney transplant rate of 4.83 pmp (5). Benefit of kidney transplantation Kidney transplantation provides better long term survival provides better quality of life and cheaper in comparison to continuing on dialysis, Types of kidney transplantation There are two sources of kidney donors, deceased donors and living donors. In Malaysia, we are practising and opt-in system where the consent of the family member is obtained prior to organ donation. Deceased Donors There have been several efforts to improve donation rate. Awareness on importance of organ donation among the general public, medical professionals, policy makers and fund providers. There is a need of continuous awareness program. The National Transplant Resource Centre (NTRC) had actively played this role in the past. However, this has slowed down due to COVID 19 pandemic and other reasons Many other initiatives had been planned and introduced at the Ministry of Health (MOH) level to strengthen the transplant program with the aim to increase deceased donor organ donation rate but due to lack of follow up actions , those initiatives failed to achieve the objectives . The MOH introduced "Unit Perolehan Organ Hospital (UPOH)" team in 2019 to focus on Intensive Care Units in large public hospitals to identify potential brain-dead donors, engaging and training intensivist and anaesthetists to perform brain stem function tests and to refer potential donors to the Transplant Organ Procurement (TOP) teams. Deceased donor kidneys allocation criteria Given the small number of kidneys from deceased donor, the eligibility criteria to be on the waiting list is strict. Previous allocation system known as Malaysian Organ Sharing System (MOSS) was introduced in 1998 (6,7). MOSS allocation system was based on a point system adopted by other countries and summarized in table 1. Due to logistics, human resource & financial reasons, it is impossible to have HLA & panel reactive antibody (PRA) tested for all patients in the waiting list especially when the transplant rate is extremely low. It is also difficult to test for HLA of the deceased donor prior to transplant. Therefore, HLA matching and PRA score has not been used for kidney allocation in Malaysia. For these reasons , the only criteria feasible in Malaysia then in determining kidney allocation is based solely on duration of dialysis. Kidney allocation systems that emphasized on waiting time place minimal attention to optimizing the use of extremely limited organs.
  (416.61 KB)