CHAPTER 7 BONE AND TISSUE TRANSPLANTATION - … · 1 CHAPTER 7 BONE AND TISSUE TRANSPLANTATION ... The total number of Tissue Transplant Notification Form ... Pusat Pengajian Sains

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CHAPTER 7

BONE AND TISSUE TRANSPLANTATION

Editors:Professor Dr Suzina Sheikh Ab Hamid

Expert Panel:Professor Dr Suzina Sheikh Ab Hamid (Chairperson)

Associate Professor Dr Azura Mansor

Contents

7.0 Introduction

7.1 Tissue Donor Hospitals and Types of Donated Tissues

7.2 Distribution of Tissues

7.3 Tissue Transplantation Data7.3.1 Reporting Centre7.3.2 Recipient Details

7.3.3 Pre-Transplant Data7.3.4 Transplant Surgery Data

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Eleventh Report of theBONE AND TISSUE TRANSPLANTATION National Transplant Registry 2014

List of Tables

Table 7.1.1 Tissue Donor Hospitals and Types of Donated Tissues sent to Bone Bank HKL, 2011-2014 ...................................................................................................... 3Table 7.1.2 Tissue Donor Hospitals and Types of Donated Tissues sent to USM Tissue Bank, 2011-2014 ........................................................................................... 4Table 7.1.3 Tissue Donor Hospitals and Types of Donated Tissues sent to UMMC Bone Bank, 2011-2014 ............................................................................................. 4Table 7.2.1 Hospitals/Centres Using Musculoskeletal Tissue Allografts Provided by Bone Bank HKL, 2011-2014 .................................................................................... 5Table 7.2.2 Hospitals/ Centres Using Musculoskeletal Tissue Allografts Provided by USM Tissue Bank, 2011-2014 ................................................................................. 6Table 7.2.3 Hospitals/ Centres Using Musculoskeletal Tissue Allografts Provided by UMMC Bone Bank, 2011-2014 ............................................................................... 7Table 7.2.4 Hospitals/Centres Using Amniotic Membranes Provided by USM Tissue Bank, 2011-2014 ...................................................................................................... 8Table 7.2.5 Type of Allograft Used/Provided from Overseas, 2011-2014 ................................. 9Table 7.3.1 Reporting Centre, 2013-2014 ................................................................................... 9Table 7.3.2.1 Gender of recipients, 2013-2014 .......................................................................... 10Table 7.3.2.2 Ethnic Group of recipients, 2013-2014 ................................................................ 10Table 7.3.2.3 Age Group of Tissue Recipient, 2013-2014 ........................................................ 10Table 7.3.2.4 Diagnosis Warranting Tissue Transplantation, 2013-2014 ................................. 10Table 7.3.3.1 Origin of Tissues, 2013-2014 .............................................................................. 11Table 7.3.3.2 Number of Transplantation by Tissue Types, 2013-2014 ................................... 11Table 7.3.3.3 Number of Transplantation by Tissue Types (breakdowns), 2013-2014 ............ 11Table 7.3.3.4 Method of Sterilisation of Tissues, 2013-2014 .................................................... 11Table 7.3.3.5 Mode of Transportation of Tissues to Recipient Hospital, 2013-2014 ................ 11Table 7.3.3.6 Temperature of Tissue Storage during Transportation, 2013-2014 ..................... 11Table 7.3.4.1 Mode of Tissue Storage in Recipient Hospital, 2013-2014 ................................. 12Table 7.3.4.2 Number of Grafts Soaked in Antibiotics Prior to Transplantation, 2013-2014 ............................................................................................................ 12Table 7.3.4.3 Usage of Systemic Antibiotics Prior to Transplantation, 2013-2014 .................. 12

eussiT latipsoH ronoDTotal2011 Femur Tibia

844 hanimA hanatluS latipsoH42 2 rupmuL alauK latipsoH42 2 ragnaK ,ertneC lacideM iatnaP

Hospital Tengku Ampuan Rahimah, Klang 42 2

02 01 01 latoT

2012 Femur Tibia 42 2 rupmuL alauK latipsoH84 4 gnaniP ualuP latipsoH42 2 akaleM latipsoH

Hospital Bukit Mertajam, Pulau Pinang 42 2

02 01 01 latoT

2013 Femoral Head Femur TibiaHospital Pulau Pinang 0 6 6 12

4 2 2 0 akaleM latipsoHHospital Sri Manjung 0 2 2 4 Hospital Seberang Jaya 0 2 2 4Hospital Tuanku Jaafar 0 2 2 4 Hospital Sultan Abdul Halim, Sg Petani 0 2 2 4

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Eleventh Report of theNational Transplant Registry 2014 BONE AND TISSUE TRANSPLANTATION

7.0 INTRODUCTION

Bone Bank Hospital Kuala Lumpur (HKL), Universiti Sains Malaysia (USM) Tissue Bank and University of Malaya Medical Centre (UMMC) Bone Bank continue to notify NTR on tissues they received/procured and provided data on tissues they had distributed.

Effort has to be made to improve documentation procedures by all the banks as it was noted that they also had updated some of the data of the previous years and had difficulty in providing the data. Donated tissue is a gift of enormous value which we have the obligation to treat with care and respect. We have to ensure the mechanism for traceability, able to identify where it had gone and how it was used.

The total number of Tissue Transplant Notification Form submitted to NTR in 2014 has increased compared to 2013. However, the number is still small and did not reflect the true scenario of bone and tissue transplantation in this country.

7.1 TISSUE DONOR HOSPITALS AND TYPES OF DONATED TISSUES

Table 7.1.1, Table 7.1.2 and Table 7.1.3 show the hospitals where tissue donation took place, the types of donated tissues and the bank where the tissues were sent to for processing, storage and distribution from 2011 to 2014.

The data shows that the number and types of procured bone sent to Bone Bank HKL had increased in 2014. However, the data from USM Tissue Bank showed it did not received any donated femoral heads from other hospital besides Hospital USM and the number of amniotic membrane donors has also reduced in 2014. UMMC Bone Bank continues its Living Tissue Donor Programme although the data shows a decreasing trend in 2014.

Table 7.1.1 Tissue Donor Hospitals and Types of Donated Tissues sent to Bone Bank HKL, 2011-2014

Hospital Sultanah Bahiyah 5 0 0 5 4 2 2 0 natnauK latipsoH

Total 5 18 18 41

2014 Femoral Head Femur Tibia Humerus Radius Hospital Kuala Lumpur 0 1 1 0 0 2

4 0 0 2 2 0 akaleM latipsoHHospital Pulau Pinang 0 2 2 0 0 4 Hospital Tengku Ampuan Rahimah 0 1 1 0 0 2

Hospital Sungai Petani 6 8 7 0 0 21 Hospital Temerloh 0 2 2 0 0 4

6 1 1 2 2 0 uawaT latipsoHHospital Sultanah Bahiyah 0 2 2 0 0 4

Total 6 20 19 1 1 47

eussiT latipsoH ronoDTotal2011 Femoral

Head Femur Tibia Humerus Radius Amniotic

membrane Hospital Tengku Ampuan Rahimah, Klang 0 1 1 2 2 0 6

Hospital Pulau Pinang 23 0 0 0 0 0 23 Hospital USM 0 0 0 0 0 166 166

Total 23 1 1 2 2 166 195

2012 Femoral Head Amniotic membrane 93 73 2 MSU latipsoH 93 73 2 latoT

2013 Femoral Head Amniotic membrane41041 gnaniP ualuP latipsoH 81 71 1 MSU latipsoH 23 71 51latoT

2014 Femoral Head Femur Tibia Humerus Amniotic membrane

Hospital USM 3 0 0 0 5 8Hospital Sultan Ismail 0 2 2 2 0 6

Total 3 2 2 2 5 14

eussiT latipsoH ronoDTotal2011 Femoral Head Femur Tibia

UM Medical Centre & UM Specialist Centre 44 0 0 44 4 2 2 0 ertneC lacideM MU 84 2 2 44 latoT

2012 Femoral Head Femur Tibia UM Medical Centre & UM Specialist Centre 12 0 0 12

4 2 2 0 holuB .gS latipsoH 61 2 2 21 latoT

2013 Femoral Head 14 14 ertneC tsilaicepS MU 56 56 ertneC lacideM MU 601 601 latoT

2014 Femoral Head Knee Slices 83263 ertneC tsilaicepS MU

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Table 7.1.2 Tissue Donor Hospitals and Types of Donated Tissues sent to USM Tissue Bank, 2011-2014

Table 7.1.3 Tissue Donor Hospitals and Types of Donated Tissues sent to UMMC Bone Bank, 2011-2014

eussiT tneipiceRTotal2011 Deep Frozen Bone

1 1 rupmuL alauK latipsoH 1 1 latoT

2012 Deep Frozen Bone 4 4 rupmuL alauK latipsoH 4 4 latoT

3102 7 gnaniP ualuP latipsoH 7 2 MSU latipsoH 2

Hospital Tengku Ampuan Afzan, Kuantan 2 22 kawaraS mumU latipsoH 2 1 liamsI natluS latipsoH 1 2 akaleM latipsoH 2 61latoT 16

4102Hospital Kuala Lumpur 13 13

31latoT 13

5


04 0 04 ertneC lacideM MUQuill Orthopaedic Specialist Centre 7 2 9

78 4 38 latoT

7.2 DISTRIBUTION OF TISSUES

The hospitals/centres where tissues were distributed and the types of tissues provided are shown in Table 7.2.1, Table 7.2.2, Table 7.2.3 and Table 7.2.4. No tendon, skin or fascia was distributed from 2011 to 2014.

Provision of deep frozen bone by Bone Bank HKL had shown an increasing trend during the period from 2011 until 2013 and slightly reduced in 2014. It is interesting to note that in 2011, 2012 and 2014 deep frozen bones from HKL Bone Bank were utilised for patients in Hospital Kuala Lumpur only. And there was no deep frozen bone transplantation carried out in Hospital Kuala Lumpur in 2013.

Freeze dried bone and preserved amniotic membrane were provided by USM Tissue Bank as it is the only tissue bank that processes bone and amniotic membrane. However, the amount of distributed freeze dried bone allograft had markedly reduced in 2014.

The data shows an increasing trend of deep frozen bone allograft provision by UMMC Bone Bank despite the reduced number of bones sent to the bank.

The data in Table 7.2.5 were provided by Bone Bank HKL. The local surgeons imported Achilles tendons for transplantation.

Table 7.2.1 Hospitals/Centres Using Musculoskeletal Tissue Allografts Provided by Bone Bank HKL, 2011-2014

Recipient Tissue Total 2011 Deep Frozen Bone Freeze Dried Bone

Hospital USM 6 5 11 Enrich Medsurg Sdn Bhd 1 0 1 Orthoplus Sdn Bhd 1 0 1 Johnson & Johnson Sdn Bhd Medical Division 2 0 2 Nuzone Medical Sdn Bhd 3 0 3 SMT Healthcare Sdn Bhd 3 0 3 Zimmer Medical (M) Sdn Bhd 5 0 5 ITL Healthcare S.E.A Sdn Bhd 2 0 2 Pusat Pengajian Sains Pergigian 0 12 12 Beau Consortium Sdn Bhd 0 4 4

Total 23 21 44

2012 Deep Frozen Bone Freeze Dried Bone Hospital USM 2 0 2 Beau Consortium Sdn Bhd 7 0 7 Perintis Medik Sdn Bhd 15 0 15 SMT Healthcare Sdn Bhd 4 0 4 Ipoh Specialist Centre 1 0 1 UM Medical Centre 0 30 30 IIUM 0 4 4 Pusat Pengajian Sains Pergigian 0 5 5

Total 29 39 68

2013 Deep Frozen Bone Freeze Dried Bone Perintis Medik Sdn Bhd 5 0 5Hospital USM 1 10 11 Lock Slead Surgical Sdn Bhd 1 0 1Hospital Sultan Abdul Halim, Kedah 1 0 1Enrich Medsurg Sdn Bhd 1 0 1UM Medical Centre 0 30 30 Osteobionics Sdn Bhd 0 10 10 Pusat Pengajian Sains Perubatan 0 1 1

Total 9 51 62

2014 Deep Frozen Bone Freeze Dried Bone Hospital USM 5 0 5Enrich Medsurg Sdn Bhd 1 0 1Victorious Medic Sdn. Bhd. 2 0 2Perintis Medik Sdn. Bhd. 1 0 1Zimmer Medical (M) Snd. Bhd. 1 0 1Hospital Seberang Jaya 0 1 1Pusat Pengajian Sains Perubatan 0 4 4

Total 10 5 15

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Table 7.2.2 Hospitals/Centres Using Musculoskeletal Tissue Allografts Provided by USM Tissue Bank, 2011-2014

eussiT tneipeceR2011 Deep Frozen Bone

Hospital Raja Permaisuri Bainon, Ipoh NR RNertneC lacideM MU RN ertneC tsilaicepS lacideM MU 44 latoT

2012 Deep Frozen Bone Hospital Raja Permaisuri Bainon, Ipoh 1

5 ertneC lacideM MU 1 ertneC tsilaicepS lacideM MU 7 latoT

2013 Deep Frozen Bone 8 gnaneP latipsoH lareneG

Hospital Sultanah Bahiyah, Alor Setar 5 3habaS ,htebazilE neeuQ latipsoH

Hospital Raja Permaisuri Bainon, Ipoh 4 7 ertneC lacideM MU 6 ertneC tsilaicepS lacideM MU 33 latoT

2014 Deep Frozen Bone Hospital Raja Permaisuri Bainon, Ipoh 8 Hospital Sultanah Bahiyah, Alor Setar 2

3 kawaraS mumU latipsoH 42ertneC lacideM MU 2 ertneC tsilaicepS lacideM MU 93 latoT

*NR: The actual number was not recorded.

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Table 7.2.3 Hospitals/Centres Using Musculoskeletal Tissue Allografts Provided by UMMC Bone Bank, 2011-2014

Recipient No. of pieces 2011

Hospital Sultanah Bahiyah, Alor Setar 30 Pusat Pengajian Sains Perubatan 30 Pusat Pengajian Sains Pergigian 1Hospital Melaka 2Hospital Queen Elizabeth, Kota Kinabalu 2Hospital Selayang, Selangor 5Hospital USM 10 Azmax Jaya Sdn Bhd 50 Taiping Medical Centre, Perak 3CryoCord Sdn Bhd 45

Total 178

2012 Hospital Melaka 3Hospital Raja Perempuan Zainab II, Kota Bharu 2Pusat Pengajian Sains Perubatan 5Pusat Pengajian Sains Pergigian 11 Hospital Duchess of Kent, Sandakan Sabah 4Hospital USM 14 Azmax Jaya Sdn Bhd 91 CryoCord Sdn Bhd 20

Total 150

2013 Hospital Sultanah Bahiyah, Alor Setar 30 Hospital Pulau Pinang 1Hospital Sultanah Aminah, Johor Bahru 3Hospital USM 9UKM Medical Centre 6Azmax Jaya Sdn Bhd 30 Transaire Sdn Bhd (Solaris Scientific) 5CryoCord Sdn Bhd 38 Vila Wangsamas 3

Total 125

2014 Hospital USM 19 Pusat pengajian Sains Perubatan 15 Pusat pengajian Sains Pergigian 9Azmax Jaya Sdn. Bhd. 62 Cyrocord Sdn Bhd 20 Hosptal Perempuan Zainab II, Kota Bharu. 2Clinic Mata, Hospital Duchess of Kent 4Klinik Mata Hospital Melaka 3

Total 134

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Table 7.2.4 Hospitals/Centres Using Amniotic Membranes Provided by USM Tissue Bank, 2011-2014

Donor Centre Recipient Tissue nodneT sellihcA 1102

Lifenet Health, USA Hospital Kuala Lumpur 14 Community Blood Center, USA 41 latoT

nodneT sellihcA 2102Lifenet Health, USA Hospital Kuala Lumpur 9Community Blood Center, USA

9 latoT

nodneT sellihcA 3102Lifenet Health, USA Hospital Kuala Lumpur 14 Community Blood Center, USA

41 latoT

nodneT sellihcA 4102Lifenet Health, USA Hospital Kuala Lumpur 2

2latoT

4102 3102 raeY n n ertneC gnitropeR 31 4 CMMU ,yregruS scideapohtrO fo tnemtrapeD 02MSUH ,ygolomlahthpO fo tnemtrapeD 00 MSUH ,scideapohtrO fo tnemtrapeD

Department of Orthopaedics, Hospital Raja Permaisuri Bainun 0 1 Department of Orthopaedics, Hospital Sultanah Aminah 0 1

0 0 MKUPP ,ygolomlahthpO fo tnemtrapeDDepartment of Orthopaedics, Hospital Umum Sarawak 0 0 Department of Ophthalmology, Hospital Pulau Pinang 0 0

516 latoT

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Table 7.2.5 Type of Allograft Used/Provided from Overseas, 2011-2014

Table 7.3.1 Reporting Centre, 2013-2014

7.3 TISSUE TRANSPLANTATION DATA

NTR had not received any notifications from health professionals who perform bone and tissue transplantation (Source Data Provider, SDP) in 2011 and 2012. However, NTR received 6 and 15 notifications in 2013 and 2014 respectively. The details are as shown below.

7.3.1 Reporting Centre

The recipient centres that reported to the NTR using the Bone and Tissue Transplant Notification Form in 2013-2014 are shown in Table 7.3.1.

Table 7.3.2.1 Gender of recipients, 2013-2014 Year 2013 2014

Gender n n 4 4 elaM 11 2 elameF

Total 6 15

Table 7.3.2.2 Ethnic Group of recipients, 2013-2014 Year 2013 2014

Ethnic group n n 7 4 yalaM 4 2 esenihC 2 0 naidnI

Bumiputera Sarawak 0 0 2 0 srehtO

Total 6 15

Table 7.3.2.3 Age Group of Tissue Recipient, 2013-2014 Year 2013 2014

Age Group n n 0 9-0 1 0 91-01 0 0 93-02 2

7 4 95-04 5 2 06

Total 6 15 84 06 naeM 35 65 naideM 02 11 DS

shtnoM 3 94 muminiM 07 97 mumixaM

Table 7.3.2.4 Diagnosis Warranting Tissue Transplantation, 2013-2014 Year 2013 2014

Diagnosis n n Ophthalmological disease 2 0

0 0 noitcefnI 0 0 amuarT

Failed primary surgery 1 4Degenerative disease 2 2Tumour- malignant 0 0

1 0 ngineb -ruomuT 8 1 srehtO

Total 6 15

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7.3.2 Recipient Details

The bone and tissue allografts recipients’ gender (Table 7.3.2.1), ethnicity (Table 7.3.2.2), age (Table 7.3.2.3) and diagnosis (Table 7.3.2.4) are presented in this section.

Table 7.3.3.1 Origin of Tissues, 2013-2014 Year 2013 2014

Origin of Tissue Graft n n 51 6 lacoL

Table 7.3.3.2 Number of Transplantation by Tissue Types, 2013-2014 Year 2013 2014

Type of tissue graft n n Deep frozen tissues 4 15

0 2 srehtOTotal 6 15

Table 7.3.3.3 Number of Transplantation by Tissue Types, 2013-2014 Year 2013 2014

Type of tissue graft n n 514 daeh laromeF 0 0 rumeF 0 0 secils eenK 0 0 suremuH

Air-Dried Amnion 2 0 Total 6 15

Table 7.3.3.4 Method of Sterilisation of Tissues, 2013-2014 Year 2013 2014

Type of sterilisation n n 51 6 noitaidarrI

Table 7.3.3.5 Mode of Transportation of Tissues to Recipient Hospital, 2013-2014 Year 2013 2014

Mode of Transport n n By hand directly from bank 5 12 By flight and/or land vehicle 1 3

0 0 ecivres reiruoCTotal 6 15

Table 7.3.3.6 Temperature of Tissue Storage during Transportation, 2013-2014 Year 2013 2014

Temperature of Storage (°C) n n Room temperature 2 0

0 4 05- ot 08- 51 0 0 ot 94-

Total 6 15

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7.3.3 Pre-Transplant Data

This section presents data on origin of tissues (Table 7.3.3.1), tissue types (Table 7.3.3.2 and Table 7.3.3.3), methods of sterilisation of the tissues (Table 7.3.3.4), mode of transportation of tissues to recipient hospital (Table 7.3.3.5) and temperature of tissue storage during transportation (Table 7.3.3.6).

Table 7.3.4.1 Mode of Tissue Storage in Recipient Hospital, 2013-2014 Year 2013 2014

n n egarotS fo edoMDeep Freezer -80 ºC 1 3 Room temperature 2 0 Bone freezer -35 ºC 1 0

2 0 Cº 02- rezeerFRefrigerator +4 ºC 0 1

10 xob ecI 7 2 gnissiM

Total 6 15

Table 7.3.4.2 Number of Grafts Soaked in Antibiotics Prior to Transplantation, 2013-2014 Year 2013 2014

Grafts Soaked in Antibiotics n n Yes 3 11

Vancomycin 2 7 Gentamycin 1 3 Ceftriaxone powder 0 1

No 3 4 Total 6 15

Table 7.3.4.3 Usage of Systemic Antibiotics Prior to Transplantation, 2013-2014 Year 2013 2014

Systemic Antibiotics n n 11 3 seY

4 3 oNTotal 6 15

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7.3.4 Transplant Surgery Data

The data on mode of tissue storage in recipient hospitals are presented in Table 7.3.4.1. This section also presents the data on the usage of antibiotics during surgery (Table 7.3.4.2 and Table 7.3.4.3).

Documents

CHAPTER 7 BONE AND TISSUE TRANSPLANTATION - … · 1 CHAPTER 7 BONE AND TISSUE TRANSPLANTATION ... The total number of Tissue Transplant Notification Form ... Pusat Pengajian Sains