Sunday, October 19, 2008

Transplant 'Tourists' at Higher Risk

This should be an alert for organ transplant candidates who are considering traveling to a foreign country for their "second chance". It's quite understandable that patients take this desperate measure when their hope starts to fade after being on waiting lists for a long time; Some kidney patients wait up to seven years for a transplant. But going to another region for a transplant can be quite risky as this article notes.

By Jody A. Charrow Renal & Urology News

PATIENTS WHO travel outside the United States for a kidney transplant—so-called transplant tourists—experience more severe post-transplant complications, including a higher incidence of acute rejection and severe infections, compared with patients who receive their transplant at a U.S. medical center, according to researchers.

Jagbar Gill, MD, of the University of California, Los Angeles, David Geffen School of Medicine, and his colleagues studied 33 transplant tourists and 66 patients who had renal transplant at UCLA. The patients were matched for age, race, transplant year, time on dialysis, donor type, and previous transplantation. Subjects were followed for an average of 16 months. Compared with the UCLA group, the tourists had shorter dialysis times.

A majority of the transplant tourists traveled to their region of ethnicity, with most receiving transplants in China (44%), Iran (16%), and the Philippines (13%). Approximately one month after receiving their kidneys, the tourists returned to UCLA for follow-up. Four patients required urgent hospitalization; three of these lost their grafts. In addition, 17 (52%) had infections, with nine (27%) requiring hospitalization. One patient lost her graft and died from complications related to donor-contracted hepatitis B. By comparison, 32 patients in the UCLA group (48.5%) had post-transplant infections, with only six (9%) requiring hospitalization.

The investigators noted that cytomegalovirus (CMV) infection was much more common among the tourists than the UCLA group (30% vs. 12%). “This may not be surprising because the majority of patients did not receive CMV prophylaxis until they returned to our center,” the researchers wrote.

After one year, the rate of acute rejection was 30% in the tourist group compared with only 12% of the UCLA-transplanted patients, according to a report in the Clinical Journal of the American Society of Nephrology (2008;3:1820-1828). One-year graft survival was 89% in the tourist group and 98% for the UCLA-transplanted group, but the difference was not statistically significant. Patient survival at one year was 100% in both groups.

Dr. Gill's group noted that the higher incidence of infectious complications may reflect issues related to tourism. These include maintaining and monitoring immunosuppression during the transition of care abroad to facilities in the United States; the lack of preventive care for infections in the period immediately following transplantation; varying infectious disease characteristics of different countries; and unclear means of donor selection.

“Transplant tourism is a risky option for patients who are awaiting kidney transplantation, and its implications on public health warrant further evaluation,” the authors concluded.

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