Dr. Janette Kwok
December 2006

A score and five years ago, Professor Gibson, the then Head of Pathology Department, the University of Hong Kong, made an important decision in establishing the Tissue Typing Service in Hong Kong. He enrolled Dr Brian Hawkins to establish the Tissue Typing Services at Queen Mary Hospital in 1981. It was then part of the Hospital Pathology Services of the Department of Pathology, the University of Hong Kong. In addition to providing laboratory services, it actively participated in research. Since the take over of the hospital services by the Hospital Authority, the Tissue Typing Laboratory became a division under the Department of Pathology and Clinical Biochemistry of Queen Mary Hospital. It is a centralised service to the entire territory within Hong Kong. The service was primarily utilised for renal transplantation until bone marrow transplantation (BMT) became available in the early 1990s. Since then the service has taken on a centralised role for all related and unrelated BMT.

Dr. Lo Chung Mao
December 2006

The first liver transplant in Hong Kong was performed at Queen Mary Hospital in October 1991. The initial development of the program was seriously restricted by a scarcity of organ donors and resources. Only a few selected patients benefited from this life-saving procedure and with little or in fact no manpower or funding, the new service was started by the extra work undertaken by the staff members and the diversion of resources from other services.

Dr. Au Wing Yan

January 2008

 

Bone marrow transplantation (BMT) is now more appropriately termed hemopoietic stem cell transplantation (HSCT), as the source of the progenitor cells is no longer confined to the marrow and may be as diverse as peripheral blood and cord blood. However, the term BMT is still popularly used interchangeable with HSCT. There are similarities and differences between marrow transplant and other solid organ or tissue transplant. BMT is used mainly to treat malignant hemic disorders. Less commonly, it is used to replace defective hemopoiesis or immune systems e.g. thalassemia and aplastic anemia. For some diseases, such as myeloma and lymphoma, the patient’s own marrow or stem cells is cryopreserved before high dose chemotherapy and is re-infused for marrow repopulation afterwards (autologous HSCT). Strictly speaking, this is not a form of transplantation, since no “donor” or immunosuppression is used. The following discussion will focus mostly on BMT involving a sibling or unrelated donor (allogeneic HSCT).

Dr. Chau Ka Foon

April 2007

 

 Renal transplantation was started in Hong Kong in 1969. Amongst 3794 renal transplants (male: 2237; female: 1557) there were 146 post-transplant malignancies (male: 73; female: 73) in 145 patients. One female patient had 2 malignancies. The overall incidence is 3.8%. When compared with the general population in Hong Kong, the relative risk of malignancy after renal transplant is 1.8 (male: 1.4; female 2.6). 18% of all malignancies developed within the first year and 53% within the first 5 years after transplant. The graft failure and patient death rate of transplanted patients with malignancy are 54.8% and 47.9% respectively. However, malignancy only accounts for 8.2% of all graft failure and 11.7% of all patient death, signifying malignancy is not the major cause of graft failure and patient death. When compared with patients with graft failure and died from other causes, patients with malignancy survived a longer post transplant period (graft survival: 7.3 years vs 4.7 years; patient survival: 7.1 years vs 5.8 years). When compared with the general population, the relative risk of death is 1.7 (male: 1.2; female 2.6). The commonest malignancies are PTLD (18%), Skin (8%), Liver (8%), Colon (7%) and Lung (7%). The relative risk is highest for Kaposi’s Sarcoma (>200), PTLD (12.3), Skin (6.0) and Thyroid (4.6). Relative risk is particularly high for carcinoma of kidney in male (RR 8.0) and carcinoma of bladder and cervix in female (RR 15.9 and 7.3 respectively). Use of anti-thymocyte antibody or OKT3 is associated with higher chance of post-transplant malignancies.