Overseas Transplants Carry Risk of Long-Term Complications

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.... to the emergency room. " In and out of the hospital for 3 months,

the patient eventually developed sepsis and central nervous system

aspergillus and died

Overseas Transplants Carry Risk of Long-Term Complications:

Presented at WTC

By Charlene Laino

http://www.docguide.com/news/content.nsf/news/852571020057CCF6852571B

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BOSTON, MA -- July 25, 2006 -- At a time when more and more North

Americans with failing kidneys are choosing to travel overseas for a

transplant, a new study suggests that patients who undergo kidney

transplantation overseas may have poor long-term outcomes.

Muna T. Canales, MD, research fellow, department of nephrology,

University of Minnesota, Minneapolis, presented the findings here on

July 25th at World Transplant Congress 2006 (WTC).

Dr. Canales said that there's no information on how many patients

are traveling overseas to receive a new kidney, liver, lung, or

other organ, " although we know it's going up. " Additionally, there

are limited data describing outcomes for U.S. and Canadian residents

who travel abroad for kidney transplants, she said.

For the study, Dr. Canales and colleagues retrospectively reviewed

the clinical outcomes of 6 men and 4 women who underwent kidney

transplantation overseas between September 16, 2002 and December 31,

2005.

Of the 10 patients, 8 traveled to Pakistan for their procedure. One

went to Iran and the other to China. The average of patients was 37

years.

In all but 1 case, patients received their kidney from a live donor.

In contrast, 35% of kidney transplants performed in the U.S. involve

live donors, Dr. Canales said.

Recipients had a variety of concomitant disorders -- 9 had

hypertension, 1 had diabetes, 1 had tuberculosis, and 1 had

cirrhosis of the liver.

The chief reason they decided to go overseas for transplantation was

that " they didn't want to stay on dialysis, " Dr. Canales reported.

Nine of the 10 had been undergoing dialysis for an average of 1.5

years.

Eight of the patients were already on the waiting list for

transplantation; the others were still undergoing evaluation. Three

told their U.S. physicians that they were planning to go overseas

for their transplant -- 1 did so 1 year before he went.

Recipients sought follow-up care in the U.S. a median of 25 days

after the procedure. Dr. Canales noted that at her institution,

kidney recipients are generally advised to " have 6 weeks of out

time " after transplantation.

In general, the transplant itself was a success. Two patients

suffered acute rejection, 1 of these was treated successfully with

antirejection drugs. One patient had to go back on dialysis.

At 2 year of follow-up, graft survival was 90% and mean creatinine

was 1. 3 mg/dL.

Four of the 10 patients developed 6 potentially life-threatening

complications. One recipient with a severe wound infection " had pus

coming out of his wound at the time of arrival in the U.S. He came

off the plane and went straight to the emergency room. " In and out

of the hospital for 3 months, the patient eventually developed

sepsis and central nervous system aspergillus and died.

Two other patients also developed sepsis, and 1 patient developed

cytomegalovirus infection. All 3 recovered.

Dr. Canales says that follow-up care was hindered by the lack of

communication between the foreign transplant team and the U.S.

physicians. " In general, we just got a piece of paper saying the

kidney transplant went well. We didn't know what medications they

were given at the time of transplant or what doses. There was little

or no information on the donor, " she said.

Physicians have to take advantage of the fact that many people

share, or at least hint at, their intention to go abroad for

transplants. Such patients should be educated about the long-term

risks before they make a final decision.

[Presentation title: Transplant Tourism -- Outcomes of United States

Residents Who Undergo Kidney Transplantation Overseas. Abstract 474]