NUH living-donor kidney transplant patients survive an average of 31 years, beating global norms

SINGAPORE – Kidney and liver transplant patients at the National University Hospital have gone on to live much longer than those in other countries, with some living-donor kidney patients surviving three or even four decades after surgery.

To commemorate their survivorship, the hospital’s National University Centre for Organ Transplantation (NUCOT) held a celebration on March 27 at The Star Vista.

It was attended by 35 patients who have survived at least 25 years after their transplant, as well as their living donors, family members and healthcare professionals.

Among them were 70-year-old Leong Sai Fan and his wife, Madam Quek Seow Chiang, 69, who donated her right kidney to him in 1997.

Dr Leong, who worked in the services sector, developed hypertension in his late 20s, though it remained well-controlled for a good number of years, thanks to regular health check-ups.

However, his condition deteriorated rapidly in late 1996, when he was 40. He lost a significant amount of weight and was put on haemodialysis from February 1997.

The waiting list for a kidney transplant at that time was at least five years, and his doctors said a transplant from a living donor would be much faster.

Dr Leong’s mother was too old, while his two sisters did not have good kidney function themselves.

His wife then stepped up and was found to be a compatible donor. The hospital then helped to obtain special approval for transplants from genetically unrelated individuals.

Madam Quek said it was her decision, and that even today, some people who learn that she had donated a kidney to her husband would praise her as though she did something great.

“To be frank, at that time there was no greatness to think about. He is the father of my children – of course, I want my husband and my kids’ father to be around. I am a very pragmatic person. I do what needs to be done,” she said. “I love him a lot, and I love my kids a lot, and that is the only reason. So it was not a difficult decision.”

Madam Quek was discharged five days after the surgery, and Dr Leong about three weeks post-surgery. They had supportive friends who stayed over at their home to help care for their children aged eight, seven and five then.

As with other transplant patients, Dr Leong was put on a lifelong regimen of daily immunosuppressants to prevent the body from rejecting or attacking the transplanted organ.

The family of five also accustomed themselves to meals prepared with as little sodium as possible, and typically less sugar and less oil too, which Dr Leong believes has helped in the transplanted kidney lasting so long.

“I was able to continue working, watch our children grow, and now enjoy being a grandfather of four. I’m deeply grateful to my wife, and to the doctors and transplant coordinators who have cared for me over the years,” he said.

Their current doctor, Professor Anantharaman Vathsala, commended the couple for their continued efforts and quipped that they had to withstand her “nagging” to stick to the medication regimen and go for regular screenings and vaccinations.

“They have gone through so much, and we want them to live a life that they deserve and what we expect for ourselves. We want to add years to their life, and we hope that we can achieve this,” said Prof Vathsala, who is NUCOT director.

Surpassing global averages

Since 1987, NUCOT has performed more than 1,400 kidney, liver and pancreas transplants, with over 900 being kidney transplants.

Globally, a kidney from a dead donor lasts about eight to 12 years after a transplant, before the transplanted organ fails to function or the patient dies.

In comparison, such transplant patients at NUCOT survive an average of 15 years and continue to have a functional kidney.

And when it comes to kidney transplants from a living donor, NUCOT patients survive 31 years on average, with the transplanted kidney still functional. In comparison, global data shows that such grafts typically fail after 15 to 20 years.

Similar positive outcomes were observed for NUCOT’s adult liver transplants. Globally, liver grafts can typically last 10 to 20 years.

The 10-year survival rate of a recipient who underwent a living-donor liver transplant at NUCOT was 78 per cent, higher than the 67.9 per cent in the US and 61 per cent in Europe.

Prof Vathsala told The Straits Times that the positive outcomes for NUCOT’s transplant patients could be attributed to the holistic and multidisciplinary care the centre delivered, as well as the efforts of the patients, donors and the Government.

These include monitoring patients regularly and closely, and annual screenings for common chronic conditions, as the immunosuppressants increase their risk of infections and complications such as diabetes, high blood pressure and kidney impairment.

As the donors were healthy individuals who took risks to donate an organ, “taking care of them for life is our commitment”, added Prof Vathsala.

She also credited NUCOT’s surgeons, transplant coordinators, nurses, pharmacists, dietitians and social workers for their expertise and dedication in ensuring the best results for patients.

The Government subsidises virtually all immunosuppressants and antiviral drugs here, which has helped to ensure that patients do not discontinue the lifelong regimen – something not many countries provide.

Prof Vathsala said success rates and post-transplant survival will continue to improve with medical advances, with more than half of those who received an organ from a living donor at NUCOT able to survive at least 25 years post-transplant.

Speaking at the NUCOT event, Professor Tan Chorh Chuan, who is Permanent Secretary for National Research and Development in the Prime Minister’s Office, said thousands of Singaporeans are diagnosed with end-stage organ failure each year, and organ transplantation has become one of the most effective treatments.

Having seen first-hand, as a nephrologist or kidney specialist, how organ failure alters the course of life, Prof Tan said: “A successful transplant restores not only organ function, but it also helps to restore a sense of normalcy – the ability to return to work normally, to travel, to enjoy your family, and to look forward to the future with confidence.”