Renal Transplantation in Hong Kong
Dr. Matthew KL Tong
August 2006

The first end-stage renal disease (ESRD) patient was put on haemodialysis in 1969 and in the same year the first cadaveric renal transplant operation was performed in Hong Kong. Since then, there had been scanty number of renal transplants done every year and it was not until 1980 that the first living-related donor renal transplant was performed. In the year 1980, Continuous Ambulatory Peritoneal Dialysis (CAPD) was introduced into Hong Kong and since then the locally prepared glass bottles of peritoneal dialysis solution which carried higher risk of peritonitis gradually disappeared from the hospital wards. In view of the shortage of cadaveric and living-related donors, the first living unrelated renal transplant was performed in 1987. The dedicated wife donated one of her kidneys to her long suffering husband. The couple has been enjoying the fruitful result of a successful renal transplant for the past 19 years.

Over the years, there has been major improvement in the renal services in Hong Kong. With the increase in renal resource allocation and improvement in expertise, there have been an escalating number of ESRD patients putting on dialysis. Currently, there are about 6800 patients on various forms of renal replacement therapies under the public sector. 82% of the dialysis patients are on CAPD. The dialysis population is also getting older and older. We have also more diabetic patients going into the dialysis program similar to other parts of the world. Unlike the old days when only the young and fit patients could enjoy this luxurious treatment, patients are recruited into the maintenance dialysis program irrespective of age and comorbid conditions. Moreover with the advances in medical technology, the quality of treatment of ESRD patients is much improved. This has included the correction of anaemia with human erythropoietin injection; the reduction in peritonitis rate with the twin-bag system; and the successful implementation of the rehabilitation program in various hospitals.

Renal transplant rate however remains low in Hong Kong because of lack of deceased organ donors. The number of cadaveric renal transplant performed in Hong Kong for the past 5 years was only 41 to 73 per year. However, the number of dialysis patients on the waiting list is 1,300. The number of living donor renal transplant has also been decreasing to less than 10 per year because of the easy accessibility to the kidney transplant program in Mainland China. Many patients instead of joining the long waiting list choose to have the transplant performed outside Hong Kong. The average number of renal transplant recipients returned from mainland China is around 200 – 250 per year. The locally performed renal transplant results on the other hand remain very encouraging with the one and five year cadaveric graft survival of 90 and 85% respectively and which are comparable with the international standards. The living donor results as expected are slightly better than the deceased donor. Of course, we should not be too satisfied with the achievement as there is room for improvement.

First of all, since the organ donation rate is low in Hong Kong, the public awareness of the constant need for cadaveric organs to save the lives of many organ failure patients should be strengthened. ‘Prevention is better than cure’ is always the golden rule of our patient management. The primary prevention of patients from having renal diseases and the secondary prevention of the progression of renal failure are the other important challenges and opportunities for the clinicians and other allied health providers. The ultimate goal is to obviate the need for renal dialysis and consign the dialysis machines to the hospital basement together with the outmoded iron lungs.