Obtaining kidney transplants abroad carries risks

NEW YORK (Reuters Health) - Patients who go outside their country of residence to have organ transplantation -- so-called transplant "tourists" -- are more likely to experience complications than patients treated within their own country, research suggests.

As the demand for kidney transplantation continues to increase, some patients needing a transplant have looked abroad for available organs. While the practice of transplant tourism seems to be increasing in the US, data on its safety is lacking, researchers warn in the November issue of the Clinical Journal of the American Society of Nephrology.

The current study suggests that "transplant tourism is a risky option for patients awaiting kidney transplantation," Dr. Jagbir Gill, from St. Paul's Hospital, Vancouver, Canada and colleagues conclude.

The study team evaluated 33 US residents who traveled to another country to have kidney transplantation, but returned to the University of California, Los Angeles for follow-up. Their outcomes were compared with those of 66 matched patients who had transplantation at UCLA.

The majority of tourists went to their country of origin for transplantation. The most common country for transplantation was China (44 percent), followed by Iran (16 percent), and the Philippines (13 percent). Transplants involving living unrelated donors were the most common.

After one year, kidney rejection occurred in 30 percent of tourists compared with 12 percent of the UCLA-transplanted patients. The incidence of infections was not significantly different between tourists and UCLA-transplanted patients, but the severity and types of infections were markedly different.

Seventeen tourists (52 percent) had at least one infectious complication, with three patients having had two or more infectious episodes. Nine patients (27 percent) were hospitalized with an infection listed as the primary cause of hospitalization.

By comparison, only six (9 percent) of the 66 UCLA-transplanted patients required hospitalization for infectious complications following transplantation. One patient in the transplant tourism group died from complications related to possibly donor-contracted hepatitis B. The investigators also noted that infections with cytomegalovirus were more common among tourists than UCLA-transplanted patients.

The higher incidence of infectious complications, Gill and colleagues say, may reflect a number of issues relating to tourism, including difficulties maintaining and monitoring immunosuppression during the transition of care abroad to facilities at home, the lack of preventive care for infections early after transplantation, the varying infectious disease characteristics of different countries, and the unclear means of selecting donors in many of these cases.

SOURCE: Clinical Journal of the American Society of Nephrology, November 2008.