title: Outcomes of overseas kidney transplantation in chronic haemodialysis patients in Taiwan.
abstract: OBJECTIVE
  Overseas kidney transplantation has often been reported to have unsatisfactory outcomes. This study aims to compare post-transplantation outcomes between overseas and domestic kidney transplant (KT) recipients in Taiwan.
  
  
  METHODS
  The Taiwanese National Health Insurance Research Database was used to identify 310 domestic and 643 overseas KT recipients, who survived for longer than 1 month after the transplantation, in a cohort of 45,453 chronic haemodialysis patients in 1997-2002. Cox proportional hazards models were used to assess risks of mortality and graft failure.
  
  
  RESULTS
  The 1, 3 and 5 year survival rates for domestic KT recipients were 96.5%, 93.3% and 91.6%, respectively, while those for overseas KT recipients were 94.9%, 87.9% and 77.1%, respectively (P = 0.015). For the overseas group, those who received a KT before 2001 had significantly higher hazard ratios of mortality and graft failure (2.85 and 1.71, respectively). However, for those receiving a KT in 2001-2002, no significant outcome difference could be found between overseas and domestic recipients.
  
  
  CONCLUSIONS
  The risk disparity between overseas and domestic KT recipients is mainly attributable to when the transplantation was performed. In attempting to dissuade potential recipients from organ trafficking, merely emphasizing the previously acknowledged poor outcomes no longer suffices as a valid reason.
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
authors.forename: Cheng-Hua
authors.initials: CH
authors.lastname: Lee
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Shi-Wei
authors.initials: SW
authors.lastname: Huang
authors.forename: Wu-Chang
authors.initials: WC
authors.lastname: Yang
authors.forename: Yu-Kang
authors.initials: YK
authors.lastname: Chang
authors.forename: Daniel Fu-Chang
authors.initials: DF
authors.lastname: Tsai
authors.forename: Ken N
authors.initials: KN
authors.lastname: Kuo
mesh_terms: D000328:Adult; D002681:China; D005260:Female; D006085:Graft Survival; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D057193:Medical Tourism; D008875:Middle Aged; D009313:National Health Programs; D010043:Outcome and Process Assessment, Health Care; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult