Objectives. Brunei Darussalam has a high prevalence and incidence of end stage renal disease (ESRD). Up until 2012, all renal transplantations were performed in overseas centres, either as government-sponsored (living-related transplantation) or as self-sponsored (commercialized transplantation) ones. We hypothesize that graft and patient survival of Brunei renal transplant patients are on a par with international standards. Materials and Methods. Data of all renal transplant patients in Brunei were analysed over a twenty-year period from registry records and case notes. Comparative survival data from other countries were obtained from PubMed-listed literature. Results. A total of 49 transplantation procedures were performed in foreign centres between 1993 and 2012. 29 were government-sponsored and 20 were self-sponsored transplantations. The 5- and 10-year overall patient survival rates were 93.3% and 90.1%, respectively. The 5- and 10-year overall graft survival rates were 91.1% and 81.2%. There is no difference in the survival outcomes of government-sponsored and self-sponsored patients. Living-related (government-sponsored) and commercialised (self-sponsored) grafts had equivalent survival to those reported in the literature. Conclusion. Our survival data was on par with those achieved in many countries. We hope to use this information to convince local stakeholders and patients to favour transplantation as the preferred modality of RRT. 1. Background Brunei Darussalam has a high prevalence and incidence of end stage renal disease (ESRD). Data from the 1st Brunei Dialysis and Transplant Registry (BDTR) revealed a prevalence and incidence of 1250 and 265 per million population (pmp), respectively, in 2011 [1]. Renal transplantation is a poorly utilised and accepted modality of renal replacement therapy (RRT) in Brunei. At the end of 2012, only 6% of the existing RRT population had a functioning transplant graft [2]. The discrepancy between the high prevalence of ESRD and low prevalence of renal transplantation has led to overdependence on haemodialysis (HD) and peritoneal dialysis (PD) therapy. Eligible ESRD patients desirous of having a renal transplant, and their screened and matched relatives, are sent under government sponsorship to endorsed overseas centres for living-related transplant operations. This practice has been increasingly prevalent in the last twenty years, especially with the growing pool of eligible ESRD patients, improving transplant awareness and the absence of a local transplant program. In addition, there are a substantial
References
[1]
J. Tan, “End stage renal disease in Brunei Darussalam—report from the first Brunei Dialysis Transplant Registry (BDTR),” Renal Failure, vol. 35, no. 8, pp. 1101–1104, 2013.
[2]
J. Tan, “Renal replacement therapy in Brunei Darussalam: comparing standards with international renal registries,” Nephrology, vol. 19, no. 5, pp. 288–295, 2014.
[3]
“Medical milestone as first kidney transplant performed,” Borneo Bulletin, 2013.
[4]
A. Vathsala and Y. C. Khuan, “Renal transplantation in Singapore,” Annals of the Academy of Medicine Singapore, vol. 38, no. 4, pp. 291–299, 2009.
[5]
Malaysian Dialysis and Transplant Registry, http://www.msn.org.my/.
[6]
Organ Procurement and Transplantation Network, http://www.optn.org/data.
[7]
UK Renal Registry, http://www.renalreg.com/.
[8]
“Australia and New Zealand dialysis and transplant registry,” http://www.anzdata.org.au/.
[9]
A. Vathsala, “Outcomes for kidney transplants at the National University Health System: comparison with overseas transplants,” Clinical Transplants, pp. 149–160, 2010.
[10]
Z. Morad and T. O. Lim, “Outcome of overseas kidney transplantation in Malaysia,” Transplantation Proceedings, vol. 32, no. 7, pp. 1485–1486, 2000.
[11]
W. Qunibi, “Commercially motivated renal transplantation: results in 540 patients transplanted in India,” Clinical Transplantation, vol. 11, no. 6, pp. 536–544, 1997.
[12]
A. J. Ghods and S. Savaj, “Iranian model of paid and regulated living-unrelated kidney donation,” Clinical Journal of the American Society of Nephrology, vol. 1, no. 6, pp. 1136–1145, 2006.
[13]
A. J. Ghods, “Renal transplantation in Iran,” Nephrology Dialysis Transplantation, vol. 17, no. 2, pp. 222–228, 2002.
[14]
C. H. D. Kwon, S.-K. Lee, and J. Ha, “Trend and outcome of Korean patients receiving overseas solid organ transplantation between 1999 and 2005,” Journal of Korean Medical Science, vol. 26, no. 1, pp. 17–21, 2011.
[15]
M. S. Sever, R. Kazancioglu, A. Yildiz et al., “Outcome of living unrelated (commercial) renal transplantation,” Kidney International, vol. 60, no. 4, pp. 1477–1483, 2001.
[16]
M. ？olako？lu, M. Yenicesu, T. Akpolat et al., “Nonrelated living-donor kidney transplantation: medical and ethical aspects,” Nephron, vol. 79, no. 4, pp. 447–451, 1998.
[17]
S. A. H. Rizvi, S. A. A. Naqvi, M. N. Zafar, et al., “Commercial transplants in local Pakistanis from vended kidneys: a socio-economic and outcome study,” Transplant International, vol. 22, no. 6, pp. 615–621, 2009.
[18]
B. Adamu, M. Ahmed, R. F. Mushtaq, and F. Alshaebi, “Commercial kidney transplantation: trends, outcomes and challenges-a single-centre experience,” Annals of African Medicine, vol. 11, no. 2, pp. 70–74, 2012.
[19]
Data from the Department of Economic Planning and Development, Prime Minister’s Office, http://www.depd.gov.bn/.
[20]
US Renal Data System, USRDS 2012 Annual Data Report, http://www.usrds.org/.
[21]
T. T. Teo, M. M. Hossain, S. Zinna, Y. P. Liew, and J. Tan, “Public opinion on renal transplantation in Brunei Darussalam,” Transplantation Proceedings, vol. 43, no. 10, pp. 3599–3603, 2011.
[22]
K. Y. Hon, S. Alam, M. Hossain, and J. Tan, “Quality of life comparisons between patients on renal replacement therapy in Brunei Darussalam,” Transplantation, vol. 94, no. 10S, pp. 806–807, 2012.
