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| Kidney transplantation in Indonesia: An update |
Tommy Supita,Eriawan Agung Nugrohob,*( ),Ardy Santosab,Moh Adi Soedarsob,Nanda Daniswarab,Sofyan Rais Addinb
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a Department of General Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Semarang, Jawa Tengah, Indonesia
b Department of Urology, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Semarang, Jawa Tengah, Indonesia |
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Abstract Objective: Indonesia has overcome several barriers to the growth of kidney transplantation within the past decade. Currently, the procedure is increasingly performed in several centers across the country. However there are limited publications on kidney transplantation from Indonesia, especially from centers outside Jakarta. This study aims to give a brief overview on transplantation performed, discuss current efforts and progresses of transplantation in Indonesia and chiefly Semarang. Methods: Retrospective analysis of 20 transplant cases in Semarang during 2014-2018 was performed. Information from other transplant centers was acquired through formal correspondences with 11 central teaching hospitals in Jakarta, Surabaya, Yogyakarta, Malang, Bali, Solo, Palembang, Aceh, Medan, Bandung, and Padang. Results: There were 629 recorded kidney transplantations performed in 12 centers, and we report on 245 cases with viable data. The average age of kidney recipients were younger (35.4 years old) compared to the donors (41.3 years old). Approximately half of the kidneys were obtained from related donors (49.0%) and there was only one case of cadaveric donor. The three leading etiologies of end-stage renal disease were hypertension (37.4%), diabetes mellitus (26.1%), and autoimmune disease (11.3%). There is only one center that has performed more than 100 kidney transplants in Indonesia. Conclusion: Indonesia has successfully overcome several major hurdles that had previously hindered the growth of transplantation. Further improvement should concentrate on the development of integrated organ transplant infrastructure, decentralization of transplant professionals, establishment of National kidney transplant database and changing the Nation's paradigm on cadaveric organ donor through public education.
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Received: 11 June 2018
Available online: 22 February 2019
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Corresponding Authors:
Eriawan Agung Nugroho
E-mail: eriawanspu@gmail.com
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| Characteristic | Value | | Age, mean (range), year | | Recipient (n = 26) | 33.0 (15-50) | | Donor (n = 26) | 46.1 (24-64) | | Sex, male/female | | Recipient (n = 26) | 18/8 | | Donor (n = 26) | 15/11 | | Donor-recipient relationship, n (%) | | Related | 19 (73.0) | | Non-related | 7 (27.0) | | Etiology of ESRD, n (%) | | Hypertension | 16 (61.5) | | Diabetes mellitus | 3 (11.5) | | Autoimmune | 1 (3.9) | | Glomerulonephritis | 2 (7.7) | | Other | 4 (15.4) | | Recipient comorbidities, n (%) | | | Coronary artery disease | 3 (17.6) | | Cerebrovascular disease | 3 (17.6) | | Pulmonary tuberculosis | 2 (11.8) | | Pleural effusion | 2 (11.8) | | Ascites | 2 (11.8) | | Hepatitis C | 2 (11.8) | | Gastric erosion | 2 (11.8) | | Depression | 1 (5.8) | | HLA Matching, n (%) | | Full match | 20 (76.9) | | 4 miss match | 1 (3.8) | | 3 miss match | 1 (3.8) | | 2 miss match | 2 (7.7) | | 1 miss match | 2 (7.7) | | Number of transplant, n | | In 2014 | 4 | | In 2015 | 3 | | In 2016 | 5 | | In 2017 | 8 | | In 2018 | 6 | | Mortality (%) | | In 2015 | 33.3 (1/3) | | In 2016 | 40.0 (2/5) | | In 2017 | 0 (0/8) | | In 2018* | 0 (0/6) | | Procedural time, mean, min | | Cold ischemic time | 8.1 | | Warm ischemic time II | 27.9 | | Total ischemic time | 36.9 | | Complications and outcome | | Mean intraoperative bleeding, mean ± SD, mL | 384 ± 192 | | Recipient mean hospital stay, mean (range), day | 11 (10-14) | | Infection, n (%) | 2 (7.7) | | Cardiovascular, n (%) | 3 (11.5) | | Total number of deaths, n (%) | 5 (19.2) | | Redialysis, n (%) | 3 (11.5) | | Retransplant, n (%) | 0 (0.0) |
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Demographics of kidney transplants in Semarang.
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Total number of transplant performed in Indonesia. The number of kidney transplant is represented by the X-axis. The bracketed year under each center denotes the period of time, which the data were reported from. The starting timelines of Bali, Aceh, Medan, Bandung, and Padang are undefined.
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| Characteristic | Value | | Age, mean (range), year | | Recipient (n = 245) | 35.4 (15-57) | | Donor (n = 245) | 41.3 (17-64) | | Age groupa, recipient/donor, year | | ≤20 | 6/3 | | 21-30 | 33/19 | | 31-40 | 29/25 | | 41-50 | 32/35 | | 51-60 | 8/21 | | ≥60 | 0/4 | | Sex, male/female | | Recipient (n = 245) | 161/84 | | Donor (n = 245) | 136/109 | | Donor-recipient relationship, n (%) | | Related | 120 (49.0) | | Unrelated | 125 (51.0) | | Kidney source, n (%) | | Living donor | 244 (99.6) | | Cadaveric donor | 1 (0.4) | | Etiology of ESRDb, n (%) | | Hypertension | 76 (37.4) | | Diabetes mellitus | 53 (26.1) | | Autoimmune | 23 (11.3) | | Glomerulonephritis | 30 (14.8) | | Other | 21 (10.3) | | Number of transplant performed, number of centers | | <10 | 7 | | 10-50 | 4 | | >50 | 1 |
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Overall demographic of kidney transplants in Indonesia.
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| [1] |
Prodjosudjadi W . Incidence, prevalence, treatment and cost of end-stage renal disease in Indonesia. Ethn Dis 2006;16(2 Suppl. 2). S2-14-6.
|
| [2] |
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS , et al. Global prevalence of chronic kidney diseaseda systematic review and meta-analysis. PLoS One 2016;11:e0158765.
|
| [3] |
Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D , et al. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant 2011; 11:2093-109.
|
| [4] |
Yoo KD, Kim CT, Kim MH, Noh J, Kim G, Kim H , et al. Superior outcomes of kidney transplantation compared with dialysis: an optimal matched analysis of a national population-based cohort study between 2005 and 2008 in Korea. Medicine (Baltim) 2016;95:e4352.
|
| [5] |
Markum HM . Renal transplantation problem in Indonesia. Acta Med Indones 2004; 36:184-6.
|
| [6] |
Bennett PN, Hany A . Barriers to kidney transplants in Indonesia: a literature review. Int Nurs Rev 2009; 56:41-9.
|
| [7] |
Mochtar CA, Alfarissi F, Soeroto AA, Hamid ARAH, Wahyudi I, B.H M , et al. Milestones of kidney transplantation in Indonesia. Med J Indones 2017; 26:229-36.
|
| [8] |
Afiatin, Khoe LC, Kristin E, Masytoh LS, Herlinawaty E, Werayingyong P , et al. Economic evaluation of policy options for dialysis in end-stage renal disease patients under the universal health coverage in Indonesia. PLoS One 2017;12:e0177436. 0177436.
|
| [9] |
The Indonesian Renal Registry Team. 8th report of Indonesian renal registry. 2015 [Accessed 1 May 2018],
|
| [10] |
Marcelino A, Mochtar CA, Wahyudi I, Hamid AR . Kidney transplantation: a new era of laparoscopic living donor nephrectomy in Indonesia. Asian J Surg 2018; 41:55-8.
|
| [11] |
Marbun MBH, Umami V, Susalit E . A 3-year survival rate of kidney transplant recipient in Cipto Mangunkusumo General Hospital in Indonesia. J Ren Med 2017; 1:1-5.
|
| [12] |
Noppakun K, Ingsathit A, Pongskul C, Premasthian N, Avihingsanon Y, Lumpaopong A , et al. A 25-year experience of kidney transplantation in Thailand: report from the Thai Transplant Registry. Nephrology 2015; 20:177-83.
|
| [13] |
Chan-On C, Sarwal MM . A comprehensive analysis of the current status and unmet needs in kidney transplantation in Southeast Asia. Front Med (Lausanne) 2017; 4:84.
|
| [14] |
Prodjosudjadi W, Suhardjono A . End-stage renal disease in Indonesia: treatment development. Ethn Dis 2009; 19(1 Suppl. 1). S1-33-6.
|
| [15] |
Perovic S, Jankovic S . Renal transplantation vs. hemodialysis: cost-effectiveness analysis. Vojnosanit Pregl 2009; 66:639-44.
|
| [16] |
Haller M, Gutjahr G, Kramar R, Harnoncourt F, Oberbauer R . Cost-effectiveness analysis of renal replacement therapy in Austria. Nephrol Dial Transplant 2011; 26:2988-95.
|
| [17] |
Indonesian Ministry of Health. Peraturan Menteri Kesehatan Republik Indonesia Nomor 52 Tahun 2016 Tentang Standar Tarif Pelayanan Kesehatan Dalam Penyelenggaraan Program Jaminan Kesehatan [accessed 02 May 2018].
|
| [18] |
Toh S, Chan M . Universal Healthcare Coverage in Indonesia - One year on [accessed 20 May 2018].
|
| [19] |
Indonesian Ministry of Health. Peraturan Menteri Kesehatan Republik Indonesia Nomor 38 Tahun 2016 Tentang Penyelenggaraan Transplantasi Organ [accessed 02 May 2018].
|
| [20] |
American Urological Association. The State of the Urology Workforce and Practice in the United States 2016. [Accessed 05 May 2018].
|
| [21] |
Palmer M, Taylor C . Workfor Predictions 2017 - British Association of Urological Surgeons. [Accessed 05 May 2018].
|
| [22] |
Kucirka LM . Improving access to kidney transplantation: referral is not enough. J Am Med Assoc 2015; 314:565-7.
|
| [23] |
Wang JH, Skeans MA, Israni AK . Current status of kidney transplant outcomes: dying to survive. Adv Chron Kidney Dis 2016; 23:281-6.
|
| [24] |
Kuo T, Yip SK, Ng CF, Ng LG, Cheng CW . Outcome of laparoscopic live donor nephrectomy and impact of double renal arteries: results from two transplant centres. Asian J Surg 2010; 33:70-5.
|
| [1] |
Liu Yu,Chen Yuntian,Liao Banghua,Luo Deyi,Wang Kunjie,Li Hong,Zeng Guohua. Epidemiology of urolithiasis in Asia[J]. Asian Journal of Urology, 2018, 5(4): 205-214. |
| [2] |
Kok Bin Lim. Epidemiology of clinical benign prostatic hyperplasia[J]. Asian Journal of Urology, 2017, 4(3): 148-151. |
| [3] |
Cheng Yang, Mushuang Hu, Tongyu Zhu, Wanyuan He. Evaluation of kidney allograft status using novel ultrasonic technologies[J]. Asian Journal of Urology, 2015, 2(3): 142-150. |
| [4] |
Rui Chen, Shancheng Ren, Chinese Prostate Cancer Consortium, Ming Kwong Yiu, Ng Chi Fai, Wai Sam Cheng, Lap Hong Ian, Seiji Naito, Tadashi Matsuda, Elijah Kehinde, Ali Kural, Jason Yichun Chiu, Rainy Umbas, Qiang Wei, Xiaolei Shi, Liqun Zhou, Jian Huang, Yiran Huang, Liping Xie, Lulin Ma, Changjun Yin, Danfeng Xu, Kexin Xu, Zhangqun Ye, Chunxiao Liu, Dingwei Ye, Xin Gao, Qiang Fu, Jianquan Hou, Jianlin Yuan, Dalin He, Tiejun Pan, Qiang Ding, Fengshuo Jin, Benkang Shi, Gongxian Wang, Xiuheng Liu, Dongwen Wang, Zhoujun Shen, Xiangbo Kong, Wanhai Xu, Yaoliang Deng, Haibo Xia, Alexa N.Cohen, Xu Gao, Chuanliang Xu, Yinghao Sun. Prostate cancer in Asia: a collaborative report[J]. Asian Journal of Urology, 2014, 1(1): 15-27. |
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