Kidney Week

Abstract: SA-PO100

Which US-Listed Candidates Travel Abroad for Kidney Transplant?

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Thomas, Alvin G., UNC Chapel HIll, Chapel Hill, North Carolina, United States

Alvin G. Thomas,

• Koons, Brittany, Villanova University, Villanova, Pennsylvania, United States

Brittany Koons,

• Shaffer, Ashton A., Johns Hopkins University, Baltimore, Maryland, United States

Ashton A. Shaffer,

• Al Ammary, Fawaz, Johns Hopkins University, Baltimore, Maryland, United States

Fawaz Al Ammary,

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine,

• McAdams-DeMarco, Mara, Johns Hopkins University, Baltimore, Maryland, United States

Mara McAdams-DeMarco,

• Kear, Tamara Marie, Villanova University, Villanova, Pennsylvania, United States

Tamara Marie Kear,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• Moriarty, Helene, Villanova University, Villanova, Pennsylvania, United States

Helene Moriarty,

• Henderson, Macey L., Johns Hopkins University, Baltimore, Maryland, United States

Macey L. Henderson,

Background

Kidney transplant (KT) candidates listed in the United States (US) wait several years to receive a transplant. Some candidates opt to withdraw from the US waitlist and receive a KT abroad.

Methods

Using the SRTR 2010-2016, we compared 364 adult KT candidates who received KT abroad to 76,133 candidates removed for deceased donor KT. We assessed factors associated with receiving KT abroad using adjusted logistic regression accounting for possible race/citizenship interactions.

Results

KT candidates who received a KT abroad were more often male (p<0.001), younger (p<0.01), college educated (p<0.001), and had private insurance (p<0.001). These candidates spent less time on dialysis (1.6 vs. 3.8 years, p<0.001), and were often first-time KT candidates (p<0.001). The likelihood of KT abroad differed by race and citizenship (interaction p<0.001). White US citizens/residents (C/R) were the reference group. White non-US citizens/non-US residents (NC/NR) had the highest odds of KT abroad (aOR: _63.27113.59_203.92, p<0.001). Hispanic C/R residents had a 2.6-fold (aOR: _1.752.60_3.84, p<0.001) higher odds and Hispanic NC/NR had a 13.9 fold (aOR: _6.0413.87_31.87, p<0.001) higher odds of KT abroad. Asian C/R had a 15.7-fold (aOR: _11.6915.67_20.99, p<0.001) higher odds and Asian NC/NR had a 34.2-fold (aOR: _14.1134.16_82.70, p<0.001) higher odds of KT abroad. The countries most frequently traveled to were the Philippines (n=93) and India (n=52) (Figure 1).

Conclusion

Although travel for transplant remains a rare practice for US-listed candidates, those with the means to travel, lower access to transplant, and possible connections outside the US might opt to travel abroad for transplant. Since follow-up care will primarily take place in the US, the nephrology community needs better data on these candidates and their post-transplant outcomes.

Funding

• NIDDK Support