Kidney Failure Kidney Transplant Our Experience Post-Transplant Outcomes

Medical Specialty Services Our Medical Achievements Resources

Kidney Failure

What is the function of kidneys?

The kidneys act as the body’s waste disposal system, filtering waste from the blood and maintaining the ideal balance of water and electrolytes. The kidneys also produce important hormones that make red blood cells, regulate blood pressure and facilitate calcium absorption.

What happens if I have kidney failure?

When the kidneys are unable to function properly – due to accident, diabetes, infection, high blood pressure, auto-immune disease – waste builds up, the water balance in the body is affected and you may feel weak, tired, nauseated and bloated. Left untreated, the kidneys can fail and toxins build-up to dangerous levels in the blood.

The only way to remove these wastes is through dialysis – where a machine acts as an artificial kidney. Unless a new donor kidney can be found, a patient has to undergo dialysis several times a week for the rest of his/her life. A kidney transplant can help a patient regain his/her health and lead a productive and fulfilling life.

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Kidney Transplant

What is kidney transplant?

A kidney transplant is a procedure where a patient receives a new donor kidney. In most cases, the patient’s own kidneys are not removed unless they are badly infected. The donor kidney is attached in the lower abdomen and will function just like a normal kidney and the patient can return to his/her normal life without dialysis.

How can a patient receive a donor kidney?

A donor kidney can come from a deceased donor or from a living donor. We all have two kidneys and a healthy individual only needs one kidney to live normally.

In Singapore, living donor kidney donations can be done between relatives (e.g. spouses, siblings, parents, uncles, aunties, cousins) or even a stranger (altruistic donation). In deceased donor kidney donation, the organ is retrieved from deceased donors under Human Organ Transplant Act (HOTA).

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Our Experience

To date, NUCOT has performed more than 700 successful adult and paediatric living and deceased donor kidney transplantations. We continue to provide post-transplant care and medical follow-ups at our Specialist Outpatient Clinic. On average, we perform close to half of the total number of kidney transplants (both living and deceased donor kidney transplants) in Singapore annually.

In 2019, NUCOT performed 43% of the total kidney transplants in Singapore (both living and deceased donor kidney transplants).¹

NUCOT is also a national referral centre for Singapore's deceased kidney donations and transplants. In 2019, we performed 64% of the total number of deceased donor kidney transplants in Singapore.¹

¹Based on 2019 annual report from the Ministry of Health, National Organ Transplant Unit.

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Post-Transplant Outcomes

NUH started our first kidney transplant in 1987, and since then, our post-transplant outcomes have been recognised internationally. Our clinical outcomes are better than or comparable with international benchmarks. Our post-transplant patient survival and graft survival rates are illustrated in the tables below:

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Medical Specialty Services

Since NUH first opened its doors for patient care in 1985, the first kidney transplant was performed in NUH in 1987. Over the years, kidney transplantation at NUH has grown in numbers, scope and complexity.

Established officially in 2008, NUCOT brings together a comprehensive multidisciplinary suite of medical specialty services required throughout our patients’ transplantation journeys.

The services available include pre-transplant medical assessments, surgical and micro-surgical specialised services, post-transplant intensive care and recovery, outpatient check-ups and lifetime medicine reviews. Our team approach ensures that transplant patients are provided with comprehensive, dedicated and individualised care.

Our transplant coordinators and other allied health professionals (such as medical social workers, transplant pharmacists and dietitians) work together to provide the required support and education to our patients and their caregivers.

Through our expertise, we are able to offer complex transplant services for suitable donor-recipient pairs, such as blood group (ABO) incompatible living donor transplants and cross-match positive living donor transplants.

In 2015, we performed the first successful living paired exchange kidney transplant in Singapore.

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Our Medical Achievements

• 1989 – Performed paediatric kidney transplant in Singapore
• 2005 – Performed combined bone-marrow and kidney transplant
• 2009 – Performed living donor kidney transplant across ABO-incompatible and positive-HLA cross match
• 2010 – Performed successful combined liver and kidney transplant on a young person
• 2012 – Performed simultaneous pancreas and kidney transplant on patient with Type 1 Diabetes in Singapore
• 2015 – Performed successful living paired exchange kidney transplant in Singapore
• 2019 – Performed simultaneous pancreas and kidney transplant on patient with Type 2 Diabetes in Singapore

In addition to its clinical services, NUCOT drives training and research in transplantation. It is accredited by the International Society of Nephrology for training in kidney transplantation and hosts fellows from all over Asia.

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Resources

Download our PDF brochures:

• English
• Chinese
• Malay

Information correct as at September 2020.

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Liver Failure Liver Transplant Our Experience Post-Transplant Outcomes

Medical Specialty Services Our Medical Achievements Resources

Liver Failure

The liver plays a critical role in digestion, immunity, metabolism and nutrient storage. It is also the body’s ‘chemical factory’, producing important proteins and blood cells while breaking down toxins.

Another amazing function of the liver is that it can restore itself when damaged. However, serious diseases can irreversibly destroy liver tissue and cause liver failure. Common causes of liver failure include hepatitis B, cirrhosis, cancer and autoimmune disease. When the liver fails, it can result in a range of serious conditions like jaundice, internal bleeding, muscle wasting and a build-up of toxins in the body. A liver transplant can help patients suffering from these conditions, regain their health and lead productive and fulfilling lives.

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Liver Transplant

With new surgical techniques and effective medications, the success rate of liver transplantation is quite high. About 90% of liver transplant recipients continue to do well one year after transplantation.

A liver transplant can take place in two ways, where the donated liver can come from either a deceased or living donor.

• Transplanting the entire liver from a deceased donor
• Transplanting a part of the liver from a living donor

Transplanting only a part of the liver is possible because of the liver’s unique ability to regenerate itself within a few weeks. When surgeons remove a piece of the donor's liver, the part that remains grows back quickly to its original size.

In adult to child liver transplant, a smaller part of the liver (the left lobe) is typically used. In adult to adult liver transplant, the larger right lobe of the liver from the living donor is used.

In Singapore, living donor liver donations can be done between relatives (e.g., spouses, siblings, parents, uncles, aunties, cousins). In deceased donor liver donation, the organ is retrieved from deceased donors under Human Organ Transplant Act (HOTA).

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Our Experience

To date NUCOT has performed more than 400 successful adult and paediatric living and deceased donor liver transplantations. We continue to provide post-transplant care and medical follow-ups at our Specialist Outpatient Clinic. On average, we perform about 70% of the total number of liver transplants (both living and deceased donor liver transplants) in Singapore annually.

In 2019, NUCOT performed 71% of the total liver transplants in Singapore (both living and deceased donor liver transplants).¹

NUCOT is also a national referral centre for Singapore's deceased liver donations and transplants. In 2019, we performed 68% of the total number of deceased donor liver transplants in Singapore.¹

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Post-Transplant Outcomes

NUH started our first liver transplant in 1990, and since then, our post-transplant outcomes have been recognised internationally. Our clinical outcomes are better than or comparable with international benchmarks. Our post-transplant patient survival and graft survival rates are illustrated in the tables below:

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Medical Specialty Services

NUCOT brings together a comprehensive multidisciplinary suite of medical specialty services required throughout our patients’ transplantation journeys.

The services available include pre-transplant medical assessments, surgical and micro-surgical specialised services, post-transplant intensive care and recovery, outpatient check-ups and lifetime medicine reviews. Our team approach ensures that transplant patients are provided one-stop with comprehensive, dedicated and individualised care within an institution.

We are well-equipped with state-of-the-art interventional radiology and endoscopy services – thereby improving graft and patient survival. This is the key to the success of liver transplantation and in managing possible ensuing complications.

Our transplant coordinators and other allied health professionals (such as medical social workers, transplant pharmacists and dietitians) work together to provide the required support and education to our patients and their caregivers.

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Our Medical Achievements

• 1990 – Performed deceased donor liver transplant in Singapore
• 1996 – Performed living donor liver transplant in Singapore
• 1997 – Performed split liver transplant in Singapore
• 2002 – Performed right lobe graft from a living donor
• 2009 – Performed living donor liver transplant in patient with porto-mesenteric thrombosis
• 2010 – Performed successful combined liver and kidney transplant on a young person
• 2016 – Performed successful altruistic non-directed donor liver transplant in Singapore
• 2018 - Performed laparoscopic retrieval on adult donor who donated to paediatric liver patient
• 2019 - Performed living donor liver transplant across ABO-incompatible

¹Based on 2019 annual report rom the Ministry of Health, National Organ Transplant Unit.

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Resources

Download our PDF brochures:

• English
• Chinese
• Malay

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For the following information, please click on the respective links:

Pancreatic Failure Pancreas Transplant Resources

Pancreatic Failure

The pancreas is a small organ connected to the stomach. It has two vital roles: producing insulin and other hormones as well as secreting digestive enzymes.

Conditions such as Type 1 diabetes (when the body does not produce insulin at all) or pancreatitis (infection of the pancreas) can cause the pancreas to fail. This can cause serious illness.

A pancreas transplant is a not a common mode of treatment, but may be considered if:

• Type 1 diabetes cannot be well controlled with standard treatment
• There are frequent insulin reactions (diabetic shock)
• Blood sugar control is poor
• There is severe kidney damage

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Pancreas Transplant

A pancreas transplant places a healthy pancreas from a deceased donor into the patient. This donated pancreas will take over the function of the failed pancreas and help produce the hormones and enzymes essential for health. A pancreas transplant is often done at the same time as a kidney transplant. A donor pancreas comes from a deceased donor retrieved for organ transplant.

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Resources

Download our PDF brochure:

• English

Our Research Goals and Achievements

Solid organ transplant recipients enjoy outstanding long term survival at the National University for Organ Transplantation (NUCOT). These results were achieved with more than 30 years of development and consolidation of clinical transplantation research at NUCOT. With these outstanding results, research in organ transplantation at NUCOT is centered on the signature of chronic allograft survival, with interest focused on:

• Antibodies that mediate chronic alloantibody mediated rejection in kidney transplants
• Cytokines and Immune Cellular profiles that mediate immunological quiescence in the presence of alloantibodies
  

Click on the respective links to view our clinical research:

• 2017
• 2016
• 2015
• 2014
• 2013
• 2012
• 2011

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National University Centre for Organ Transplantation (NUCOT) offers a broad spectrum of care. These services are provided within advanced facilities to allow management and treatment of our patients.

For contact details, operating hours and directions to NUCOT Specialist Outpatient Clinic, click here.

Getting a Transplant

The road to preparing for and getting a transplant, as well as post-transplant life is a long, challenging but ultimately a rewarding one. You may feel excited, nervous and uncertain about the process. At NUCOT, our team of doctors, nurses, and allied healthcare staff are here to guide you along your transplant journey.

As a transplant patient, arming yourself with knowledge is the first step to managing your expectations, clearing up doubts and empowering yourself with the information to enable better self-care.

If you are at the end-stage of organ failure and a candidate for organ transplant, your doctor will refer you to a transplant coordinator. He or she works together with the transplant team to evaluate your suitability for a transplant. This means assessing if you are well enough to undergo the transplant surgery, the extent of your disease and whether you are suitable for transplantation.

Understanding the Risks

As with any major surgery, there are risks involved. These risks, as well as the benefits of a transplantation, will be explained to you. This will help you make an informed decision. As a patient, you have the right to accept or decline a transplant. Your decision will be respected.

Should you accept to go ahead with a transplant, you will be placed on the relevant organ transplant waiting list. This is where you wait for a suitable organ from a deceased donor to be available.

The Waiting List

Each time a donor organ becomes available, it will be matched to the blood group, weight and urgency of the patients on the waiting list. The best-matched patient will receive the organ.

The wait can be a difficult and long one. It is normal to feel worried and uncertain. There may be some false alarms, for instance, if the donor organ is not ideal for transplant or if you happen to be ill that day. Our transplant team will be there to offer support in this challenging time.

Be sure to keep your contact details updated so that you can be readily contacted when an organ becomes available.

Prepare for a Transplant

In the time leading up to a transplant, our team will work to ensure that you are in the best of health, both physically and emotionally.

You will also need to undergo a range of tests and screenings. These will help doctors ensure a better match and also identify any risks.

• Blood type: Your blood type should be compatible, even if it is not the same as, the organ donor.

• A cross-match blood test: This checks how your antibodies react to the donor’s and determines how high the chance of rejection is.
• Antibody screening: The panel-reactive antibody (PRA) test measures your antibodies against other people’s. If you have a wide range of antibodies against others, there is a higher risk of organ rejection, even if the cross-match shows a good match.
• Tissue type test: This is a blood test for your genetic makeup. The more of genetic markers you share with the organ donor, the more likely your body will accept the donor organ.
• A mental health assessment: In living donor transplants, both the donor and organ recipient will need to be assessed for any psychological issue.

This pre-transplant assessment is aimed at ensuring the best chances for a successful organ transplant. The more matches there are, the more likely your body will accept the new organ. As a donor, you may also need to undergo x-rays, scans and other screenings as determined by your doctor.

The Transplant Operation

When an organ becomes available for transplant and doctors determine it is the best match for you, you will be contacted to head down to the hospital. There is a chance that even when a donor organ is found, the organ may become unsuitable during the retrieval process. In the event that you have an infection (a flu, cough or fever), you will also not be a suitable candidate for transplant. Should the donor organ be a suitable match to you, an operation time will be set and a series of tests – ECG, blood tests and x-rays, will be done before the operation.

In cases of living donor transplant (e.g., liver or kidney), the donor and recipient will be scheduled for the operation on the same day. The donor will start his/her operation first to retrieve the donated organ and the recipient will start the operation slightly later to receive the donor organ.

The transplant operation is a major procedure and your medical team will need to monitor you closely while it happens. While you are under general anaesthesia, a number of drips and devices will be put in.

• Central venous catheter (CVC or ‘central line’) to receive medication and retrieve blood for tests
• Intravenous (IV) line to receive saline or medication
• Endo-tracheal tube (ETT) to help you breathe during the operation
• Nasogastric tube to drain stomach secretions
• Urinary catheter to drain urine
• Drainage tubes to drain away fluid and blood from the operation site

Life After a Transplant

Preventing organ rejection

There will also be some challenges. The biggest will be to prevent organ rejection. Since the donated organ is not your own, you body’s natural response is to attack it. To prevent the immune system from attacking your transplanted organ, you will need to take anti-rejection medications called immunosuppressants. Often that is a cocktail of a few different drugs. These medications prevent your immune system from attacking or rejecting the new organ. Typically, you must take these medicines for life.

You may also be given other medications. These may help the anti-rejection drugs perform better or control their side effects. If you have other medical conditions, you may need to take medicines for these as well.

Taking care of your transplanted organ:

• You may need to go for frequent blood tests and check-ups in the first year of your transplant. These appointments and blood tests may be tapered down over time depending on the health of your transplanted organ.
• You need to take your immunosuppressants and medications as prescribed.
• Take more precautions against falling ill. Your weakened immune system (to prevent rejection) will mean you may be more susceptible to infections. Practice good hygiene at all times and stay away from people who are ill with an infectious disease (cold, flu, fever, etc.).
• Monitor your health. Be aware of how you feel and do self-monitoring if required. This includes checking your weight, temperature, blood pressure and pulse daily. If you are diabetic, monitor your blood sugar.
• Practice good dental hygiene and make regular appointments to see your dentist.
• Live a healthy lifestyle: exercise regularly, eat a balanced diet, manage stress and get adequate sleep.

The Benefits of Living Organ Donations

With the increased incidence of chronic disease leading to organ failure, there is gap between organ demand and supply of donor organs.

As of 2019, more than 350 people are on the organ waiting list, and the wait for a donor organ to become available can average nine years.

Living-related donation thus an important and life-saving option. Being a living donor is a selfless act of giving. All potential donors are carefully screened to ensure that they are healthy. Living related organ donation also results in better outcomes for the recipient.

• Improved viability of the donated liver or kidney
• More accurate matching of liver size and immune compatibility between donated organs and recipient· Pre-arrangement of transplant can ensure that conditions are optimal
• Living-related donations can be offered at an earlier stage, so recipients can undergo the operation in a better state of health

Being An Organ Donor

Anyone has the potential to be an organ donor. The criteria to determine if an organ is suitable for donation is based on a set of medical standards and not dependent on age or gender.

In Singapore, Singapore Citizens and Permanent Residents above the age of 21 and above, and are not mentally disordered, are included under the Human Organ Transplant Act (HOTA). HOTA allows for organs (kidney, liver, heart and cornea) to be donated in the event of death for the purpose of transplantation.

Over the years, HOTA has been widened in scope so as to grow the organ donor pool. This has meant more people waiting on the transplant list have successfully gotten a life-saving organ. Despite the widening of HOTA, hundreds of people are still waiting for an organ to become available. This is where living organ donation comes in, an area also under the regulation of HOTA. Living organ donation further increases the chance that a suitable kidney or liver can be found.

To find out more about HOTA visit LiveOn.

Anyone can also volunteer to be a living organ donor as long as you are above 21 years of age. This selfless act will extend the life of your loved one. Speak to his/her medical team to learn more about how to be evaluated as a potential donor.

To be a living organ donor, you need to be free of chronic disease and undergo a series of tests. Read about the donor assessment process.

The Donor Assessment

The living donor assessment is a rigorous process to ensure that the potential organ donor is in a good state of health and that the donation will not compromise his/her own well-being.

Two types of organs are suitable for live organ donation:

• Kidney: We all have two kidneys and the body can function just as well with one kidney.
• Liver: The liver is the only organ that can regenerate or rebuild itself. After the transplant, the livers in both donor and recipient will grow back to normal size in about two months.

During the donor assessment, a multidisciplinary liver transplantation team evaluates the donor based on several factors to ensure suitability.

• The potential donor will need to undergo a series of blood tests and scans to ensure the organ is a ‘match’.
• Physical health: The donor must not have any disease that could be potentially transmitted to the recipient.
• Mental health: The donor must not have an active mental disorder or intellectual impairment.
• He/she must not have a history of drug use.
• A counselling session is also arranged to determine the psychosocial state of the potential donor. The session may include personal questions.
• An independent transplant ethics committee evaluates this information and makes the decision about whether the live organ donation can go ahead.

All these are done to ensure that the potential living donor is as healthy as possible so that the surgery can be done safely.

What are the risks of being a living donor?

As with any major operation, there are risks of donating an organ. Some of these include:

• Risk of death
• Risk of perioperative death for liver transplant is 0.2-0.5%
• Risk of perioperative death for kidney is 0.03%
• Post-operative infection
• An allergic reaction to the anaesthetic
• Excessive bleeding or clots

These risks are small, but it is important to be aware of them. Discuss any concerns you have with the transplant surgeon or transplant coordinator.

Is it safe to be a donor?

While the risks exist, current research indicates that organ donation does not shorten the donor’s life. Neither does it impair the ability to have children or increase the risk of health problems. Some studies indicate that donors in fact live longer lives – perhaps due to the stringent criteria for assessment; only healthy people are suitable for an organ donation in the first place.

To support your loved one in their transplant journey, it is important to understand the advantages, risks, steps and areas of precaution.

The information in this website is meant to help dispel some of the unknowns, myths and fallacies about organ donation.

As a family member, friend or even colleague or boss, it’s important to be aware of some of the issues that may affect an organ recipient.

• He/she may need to go for frequent blood tests or doctor’s appointments. These may take time and some tests require fasting or special methods of collection. All this may have a small impact on recipient’s social life, work or school schedule.
• He/she may not necessarily be '100%' right away. Side effects from medications may cause hair growth, acne, mood swings, and weight gain due to the high dosage. These symptoms diminish as the doses are tapered down. Be supportive and understanding about these symptoms.
• Be on the lookout for any emotional issues. Depression, guilt, and stress may arise after a transplant.
• Help him/her lead an active and healthy lifestyle. Exercise together or share healthy recipes.
• Take precautions if you are ill. Organ recipients have little immunity to many diseases due to their medications. If you have a cold/flu/fever or any other infectious disease, do stay away or wear a surgical mask. Practice good hygiene at all times.

If at any point you are unsure of what to do, seek advice from a medical professional or the organ recipient’s transplant coordinator.