title: Transplant tourism: Outcomes of United States residents who undergo kidney transplantation overseas.
abstract: BACKGROUND
  Although international commerce in kidney transplantation is a reality, little is known about U.S. residents who travel abroad for kidney transplantation.
  
  
  METHODS
  We retrospectively reviewed the clinical outcomes of patients who were evaluated at the University of Minnesota Medical Center or Hennepin County Medical Center, but then surreptitiously underwent kidney transplantation overseas.
  
  
  RESULTS
  We identified 10 patients who underwent kidney transplantation outside the United States between September 16, 2002 and June 30, 2006 and then returned for care in our programs. Eight were transplanted in Pakistan (all Somali), one was transplanted in China (Chinese), and one was transplanted in Iran (Iranian). All but one had a living donor. Mean age was 36.8+/-12.5 years with median follow-up of 2.0 years (range 0.4-3.7). Three patients communicated their intent to travel abroad before transplantation. Induction immunosuppressive therapy (if any) was available in 3/10, and initial maintenance immunosuppression was known in 5/10. Complications were primarily infectious, with six potentially life-threatening infections in four patients. At last follow-up, mean serum creatinine was 1.13+/-0.34 mg/dL, acute rejection occurred in 2/10, 1/10 grafts failed due to acute rejection, and 9/10 patients were alive.
  
  
  CONCLUSIONS
  Kidney function and graft survival were generally good after surreptitious overseas kidney transplantation. Major problems included incomplete perioperative information communicated to the posttransplant care facility and a high incidence of posttransplant infections. Longer follow-up and detailed cost analysis are needed to better understand the implications of the growing phenomenon of transplant tourism.
authors.affiliation: Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Muna T
authors.initials: MT
authors.lastname: Canales
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D014195:Travel; D016896:Treatment Outcome; D014481:United States