News and Announcements
NTR office has been relocated to Level 5, Menara Wisma Sejarah, 230 Jalan Tun Razak,
50400 Kuala Lumpur, Malaysia.
The new telephone and fax numbers are 03-2681 5948 and 03-2681 5949 (fax).
of the 1st Report of National Transplant Registry 2004
The 1st Report of National Transplant Registry was finally
published. The report was launched officially by Minister
of Health, Y.B. Dato’ Dr. Chua Soi Lek at Auditorium Utama,
Selayang Hospital on 20th December 2005
The event was jointly organized by Malaysian Society of Transplantation,
National Transplant Registry and National Transplant Resource
Centre, HKL. A total of 200 participants were present to witness
the launching of the report. They were mainly doctors and
paramedics from various MOH hospitals, universities and private
centres that are involved in transplantation services in the
Following the launching, Dato’Dr.Zaki Morad spoke on the
“Challenges in Setting up NTR”. The editor, Dr. Hooi Lai Seong,
gave an introduction on the overall of the report. Then each
section of the report was presented by various speakers;
- Blood and Marrow Transplantation by Dr. Alan Teh Kee
- Cornea Transplantation by Dr. Shamala Retnasabapathy,
- Heart & Lung Transplantation by Mr. Mohamed Ezani
- Heart Valve Transplantation by Mr. Mohamed Ezani Md.Taib,
- Liver Transplantion by Dr. Tan Seok Siam,
- Renal Transplantation by Dr. Goh Bak Leong,
- Bone & Tissue Transplantion by Dr. Suzina Sheikh Ab.Hamid,
- Cadaveric Organ and Tissue Donation by Dr. Lela Yasmin
The seminar ended with a note of thanks from the chair, especially
to all the speakers and participants.
photos in the picture gallery.
NTR is an affiliated member of the Association of Clinical
Registries, Malaysia (ACRM), which was established in 2005.
ACRM was conceived through the joint efforts of a variety
of Health and IT professionals with an interest in the development
of clinical databases and disease registers in Malaysia. For
further information about ACRM, please visit http://www.acrm.org.my/
XX International Congress of the Transplantation Society
5-10 September 2004
This year actually marked the 50th anniversary of the first
identical twin kidney transplant, which demonstrated to the
world the first time that long-term function of a grafted
organ in humans was possible. And Vienna, the ever enticing
and glamorous cultural capital of Europe was chosen to be
the host not only because of its sweet Viennese breeze that
come off the outdoor café which served the appetizing and
famous Sacher Cake with a mix of classical music, but Vienna
was also the place where the first successful kidney transplant
in dogs was carried out one hundred years ago, which marked
the birth of transplant surgery.
There were more than 4000 participants from around the world
attending this exciting meeting. The Congress boast a robust
scientific programme featuring 6 plenary sessions, 30 state
of the art symposia, 483 oral presentations, and more than
1250 posters. It covered the full gamut of transplantation
basic science and clinical application.
The Congress highlights include:
• Discussion of the ethics of live donations for liver and
Organ trafficking and donor coercion was the major concerns.
A special early morning session was held on the second day
where the report of the Amsterdam Forum on the live kidney
donor was presented. Kidney transplant community met in Amsterdam
from April 1-4, 2004 for this Forum. The main objective was
to develop an international standard of care for the live
kidney donor. The international transplant community recognizes
that the use of kidneys from living donor needs to be performed
in a manner that will minimize the physical, psychological,
and social risk to the donor and does not jeopardize the public
trust of the healthcare personnel. The donation decision should
be done in an environment that enables the potential donor
to decide in an autonomous manner. There were 6 consensus
statements in this report (refer
Transplantation vol 78, Number 4, August 27, 2004 for the
full report). The Forum also recommended that transplant
center should form a Donor Advocate to minimize the occurrence
of “conflict of interest” and to provide a healthcare professional
advocating the welfare of the potential donor. In order to
minimize coercion and enhance autonomous decision-making,
a “cooling off period” and assessment of donor retention of
information should be routinely practice. Another important
statement is Medical Judgement versus Donor Autonomy.
It is stated that donor consent and autonomy is necessary,
but not sufficient, to proceed to kidney donation. Medical
evaluation and concurrence is essential. Donor autonomy
does not overrule medical judgement and decision-making
(note: in my opinion this is the most important statement
in the report, GBL). Lastly this Forum also proposed the establishment
of Donor Registry.
Promising and exciting results of recent efforts to transplant
swine organs to primates. (Note: that is all I am going to
New data on tolerance by chimerism and co-stimulation blockage.
Over the last decade, scientists had moved beyond the conventional
co-stimulatory molecules (CD 28/CD80 and 86, CD154/CD40) and
co-inhibitory molecule (CTLA4/CD80 and 86). Many new molecules
which belong to the B7 and TNF receptor superfamilies, which
potentially can play a pivotal role in tolerance induction
were identified. Some of the new exiting molecules to remember
are OX40(TNFSF4, CD134), 4-1BB(TNFSF9, CD137 and LIGHT(TNFSF14).
There is an international collaboration designed to accelerate
the clinical development of immune tolerance therapies (ITN).
The aim of this ITN is to shift from the current immunosuppressive
practice which works on the basis of blanket suppression of
the immune response to a new paradigm which uses “tolerance
agent”, i.e. one that can produce long-term survival of transplanted
organs, without continuous therapy, without the development
of chronic rejection and without evidence of immuno-incompetence.
One of the approach is Chimerism which simply means persistent
donor cells in recipients. The current strategies use 2 steps
approach: firstly, obliterate normal immune system with immunosuppressive
drugs, antibody (ATG, anti-CD2, Campath 1h) and irradiation,
and secondly, provide renewable source of tolerogen (donor
specific antigen e.g. blood, bone marrow, stem cells, etc).
• Humoral rejection
• Diagnosis of antibody-mediated rejection is dependent on
a triad: circulating donor specific antibody, characteristic
pathology (C4d staining), and characteristic clinical picture
(acute antibody-mediated rejection, hyperacute rejection,
transplant glomerulopathy). Management is usually suboptimal.
Prevention is the key, and can best be achieved by identifying
individual at risk and using heavier induction and maintenance
immunosuppression (e.g. FK506 and MMF, anti-CD20). Other strategies
include removal of antibody with pheresis, use of IVIgs. The
mechanisms involved are still poorly understood. The need
for further research and large scale trials to evaluate strategies
to manage this condition will be one of the major developments
in the next decade.
• Registry Scientific presentation
• There is abundance of report from various registries around
the world and most of these are of highest quality scientific
data. Among some of the interesting papers are:
• Observation by Paul Terasaki et al that unrelated donors
yield higher graft survival rates than parental donors in
patients with IDDM, polycystic kidney disease and FSGS. One
of the possible explanations is susceptibility to kidney damage
exists in these 3 conditions is also inherited from the parent.
Terasaki et al even go to the extend to recommend that unrelated
donor should be preferred over parental donor in these 3 conditions.
• Observation by Lentine et al (base on USRDS data) showed
that recipient age, DM as cause of ESRF, history of angina
and peripheral vascular disease, older donor, cadaveric donor,
DGF, post-transplant DM and graft failure are independent
predictors of post transplant myocardial infarction. Female,
Afro-American, Hispanic and employment are associated with
lower risk. Interestingly, duration of dialysis before transplant,
HLA matching, CMV status, and type of maintenance immunosuppressions
are not predictors for post transplant MI.
• Woodward et al based on USRDS data observed that the increasing
usage of tacrolimus in US in recent years do not show advantage
in graft survival when compared to cyclosporin. Furthermore,
in Woodward’s conclusion, he stated that given the higher
cost of FK compared to CsA and the similar risk of graft failure,
further studies should be conducted to define those patient
groups for which FK might be cost-effective. This is most
interesting as in Chapter 6 of the 11th NRR report, we observed
that those who received tacrolimus or MMF had better graft
survival than those on cyclosporin. And when this was adjusted
for other co-variates, the advantages with FK and MMF become
more apparent. I attributed this observation to MOH practice
where FK and MMF are reserved for patients with higher risk
of graft rejection.
• New Compound
• FK778 by Fujisawa is currently in Phase II trial and the
results so far is promising. This will further extend Fujisawa
immunosuppression armamentarium. The molecule has some similarity
One of the most important observations by the Transplantation
Society in recent years is the striking differences in the
transplantation activities between the developed and developing
countries. Hence, the Transplantation Society is embarking
on an international effort to make safe organ transplantation
available worldwide. Led by Drs. Carl Groth and Jeremy Chapman,
the Society has been working with WHO and other prospective
partners to lay the groundwork for the Global Alliance in
Transplantation (GAT). The Vienna Congress heralded a new
era of globalization for the Society. This was the first meeting
to establish a Global Alliance in Transplantation (GAT) with
the following missions:
1. development of a world registry for all organ transplants
2. development of live donor registry
3. educational enhancement by the creation of fellowships
and sister institutions
4. development of standard and guidelines for transplantation
Goh Bak Leong
NTR – Cornea Transplant Workshop: Briefing on the Cornea
Transplant Clinical Registry Forms
Date : 20th August 2004
Time : 9.00 am – 12.15 noon
Venue : Auditorium 1, HKL
The objective of having this workshop is to introduce the
Cornea Transplant Notification Form and Cornea Transplant
Outcome Forms to all the MOH doctors and paramedics who are
involved in the Cornea Transplant services.
A total of 20 doctors and 24 nurses / medical assistants attended
Dr. Shamala gave a presentation on cornea transplantation
after her welcoming speech. During her presentation, she stressed
on the importance of registry. She added that by collecting
a comprehensive local data would improve the medical services
benefited by the patients. This was followed by an introduction
of NTR by Dr. Sanjay from Clinical Research Centre.
The participants were later briefed on the Cornea Transplant
Notification and outcome form by Dr.Shamala. After explaining
the data elements on the forms, there was a hands-on training
session for the group. They were asked to fill up the Notification
and Outcome Form according to the case study presented. Dr.Sahimi
highlighted the important points of the form to the group
during the Q & A session.
Dr. Goh Pik Pin ended the session by presenting the findings
and outcome of the National Cataract Surgery Registry data.
Overall, the workshop was successful as we received many constructive
criticism suggestions from SDP to improve future notification.
Concurrent Workshop for Renal Transplant Nurses on 8th
Scientific Meeting of the Malaysian Society of Transplantation
Date : 5th August 2004
Time : 2 pm – 6 pm
Venue : Hotel Shangri-La’s Rasa Sayang, Penang
In conjunction with the 8th Scientific Meeting of the Malaysian
Society of Transplantation on 5-7 August 2004, NTR organized
a workshop for the renal transplant nurses. The objective
of this workshop is to introduce the new Clinical Registry
Forms (Renal Transplant Notification Form, Renal Transplant
Outcome Form and Renal Transplant Annual Return Form).
A total of 32 nurses attended the workshop, of which 25 nurses
were from MOH hospitals, 3 from private medical centres and
4 from universities. This workshop was sponsored by the Malaysian
Society of Transplantation (MST), National Transplant Registry
(NTR) and pharmaceuticals companies ( Janssen-Cilag and Roche).
Dr.Goh BL briefed all the nurses on the Clinical Registry
This was followed by hands-on session for the nurses to fill
in the form according to the case study presented. All the
participants were very enthusiastic to do the exercise.
The participants were given very informative talk on “CPG
On Live Donor Workup”, “Recipient Preparation” and “Post Transplant
Care” from Dr.Wong Hin Seng, Dr.Shahnaz Shah and Dr.Hooi Lai
NTR-BMT Web Application Launching on 30 April 2004
NTR proudly launched its first web application for the Blood
and Marrow Transplantation.
Dato’ Dr. Zaki as co-chair for the NTR gave his welcoming
speech to all the BMT doctors and nurses from various hospitals
and institutions. Dr.Lim Teck Onn as head of CRC also presented
the slide and titled “Disease& Treatment Registry Thru
the Web, The Way Forward”.
View the Slide
The expert members of the BMT gave their full support to make
this web application launched smoothly. Now the BMT team members
who are registered in NTR as a user can access their own centre
data through web.
NTR wish to take this opportunity to thank all the doctors,
nurses and the team members of CRC and TRU who made this launching
NTR wish all the BMT team members keep up their good job to
support the NTR.
1st Governance Board meeting on 25 March 2004
NTR 1st Governance Board meeting was held in HKL. A total
of 28 members attended to the meeting. They are representing
from various societies which involving organ or tissue transplantation
Chairman of the NTR, Tan Sri Dato’Dr. Yahya Awang given a
brief introduction of NTR to the members. The objectives of
the meeting were to formalize the NTR Governance Board and
briefed the members of the Governance Board Manual regarding
the role and responsibilities as a member.
The next meeting is scheduled in two months time to follow
up on the outstanding issues.
The 1st NTR Expert Panel meeting, held from 16th- 17th January
at Vistana Hotel, Kuala Lumpur has been successfully carried
NTR expert panel consists of 6 disciplines of organ/tissue
transplantation in Malaysia. They are Blood and Marrow Transplant,
Heart and Lung Transplant, Liver Transplant, Renal Transplant,
Cornea Transplant and Bone/Tissue Transplant.
This meeting is to gather all the experts from various hospitals,
institutions and universities to initiate the NTR.
Committee for each respective discipline has been formed.
(Please refer to the Expert Panel list)
The role of the Expert Panel is :
1. To undertake Quality Control of the Clinical Registry Form
and the Data Dictionary
2. To undertake Quality Control of the reported data
3. To undertake literature review in the relevant area
4. To interpret the results generated by NTR’s statistician
5. To write the section of the NTR report relevant to his
or her expertise
6. To specify the data reporting producer
7. To facilitate access to source documents for the Transplant
Registry Unit (TRU staffs to do the data verification
All the members of the expert panel contributed their great
ideas to formulate the Clinical Registry Form for each respective
The meeting has achieved its objectives.
NTR sponsor meeting was carried out on the same day. The official
sponsors of NTR are as below:
1. National Transplant Coordinating Committee
2. Medical Development Division, MOH
3. Malaysian Society of Transplantation
4. Clinical Research Centre, HKL.
The sponsor group also nominated the names for Governance
Board of the NTR. Governance Board meeting will be held on
TRU would like to take this opportunity to thank all who had
kindly contributed to make NTR a reality.
View the meeting photos in the picture