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논문분류	춘계학술대회 초록집
제목	The Brunei National Kidney Transplant Program - A 10 Year Analysis
저자	Nur Hanisah Haji Johan
출판정보	2024; 2024(1):
키워드
초록	Brunei, with the smallest population in Asia, started its national program in 2013. The program stands on its four core principles equity, quality, sustainability, and morality. The program overcame many barriers: technical, religious, cultural, political, and legislative since its inception in 2013. The program was initially guided and mentored by foreign expertise, but since 2019 local surgeons have performed independently through a multi-disciplinary approach involving general, vascular, and urological surgeons. By the end of 2023, the point prevalence of treated End Stage Kidney Failure was 2233 per million population, corresponding to 1018 prevalent patients on Kidney Replacement Therapy. Brunei’s local Transplant incidence rate for 2023 was 15 per million population amongst the highest in Southeast Asia (including kidney transplant operations sent abroad by the government). The progress of the program was hampered by the COVID-19 pandemic (2020-2022), when transplantation activities were limited. Over 10 years, the program has successfully conducted 20 living related donor kidney transplantation surgeries, with increasing momentum after the pandemic. 2 cases required re-exploration after transplantation because of bleeding complications. All patients received either basiliximab or anti-thymoglobulin induction, with maintenance therapy on mycophenolate mofetil, tacrolimus, everolimus and steroids. Infectious complications include mycobacterium tuberculosis (n=2), invasive cytomegalovirus disease (n=3) and BK nephropathy (n=6). At the end of 2023, 18 patients had well-functioning graft kidney, and 2 patients reverted to dialysis through recurrence of glomerular disease. We hope to consolidate and expand the national program in the next few years by incorporating innovative exchange schemes and commencing a deceased donor program. Ensuring viability and sustainability is an important goal for the country, given the small population and limited expertise within the country. Deterring commercialization, augmenting experiential learning environment, and improving public confidence remain to be important goals for the fledgling program.
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