Transplantation in foreign nationals: Lower rates of waitlist mortality and higher rates of lost to follow-up posttransplant

Nicole D. Ferrante, David S. Goldberg

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

A controversial issue in the transplant community is whether or not to provide deceased donor liver transplantation (DDLT) to noncitizen/nonresidents (NCNRs) who travel for liver transplantation (LT). The expectation is that transplantation of NCNRs will not compromise access for US citizens/residents (USCRs), and that NCNRs would have similar post-LT follow-up. This has never been formally assessed. The United Network for Organ Sharing (UNOS) data from February 27, 2002 to December 31, 2016 were used to identify NCNRs and compare to USCRs, excluding Status 1 adults. Multivariable logistic regression was used to analyze waitlist outcomes, and competing risk analysis was used to assess rates of lost to follow-up post-LT. From February 27, 2002 to December 31, 2016, 1260 NCNRs were listed for LT (0.86% of listings). Adjusted probability of DDLT was not significantly different for NCNRs and USCRs (P >.5), but NCNRs were significantly less likely to be removed from the waitlist for death or clinical deterioration (aOR: 0.80, 95% CI: 0.69-0.93, P =.003). In multivariable competing risk models, NCNRs had an 11-fold higher risk of being lost to follow-up after accounting for the competing risk of death (SHR: 11.44, 95% CI: 8.72-15.01, P <.001), as well as lower rates of posttransplant mortality (SHR: 0.67, 95% CI: 0.49-0.91, P =.012). Our findings speak to the need to standardize practices for NCNRs and set expectations for post-LT care.

Original languageEnglish (US)
Pages (from-to)2663-2669
Number of pages7
JournalAmerican Journal of Transplantation
Volume18
Issue number11
DOIs
StatePublished - Nov 2018
Externally publishedYes

Keywords

  • clinical research/practice
  • ethics and public policy
  • liver transplantation/hepatology
  • organ allocation
  • patient survival
  • recipient selection
  • United Network for Organ Sharing (UNOS)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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