title: Increased risk of post-transplant malignancy and mortality in transplant tourists: a nationwide population-based cohort study in Taiwan.
abstract: Information on post-transplant malignancy and mortality risk in kidney transplant tourists remains controversial and is an important concern. The present study aimed to evaluate the incidence of post-transplant malignancy and mortality risk between tourists and domestic transplant recipients using the claims data from Taiwan's universal health insurance. A retrospective study was performed on 2394 tourists and 1956 domestic recipients. Post-transplant malignancy and mortality were defined from the catastrophic illness patient registry by using the International Classification of Diseases, 9th Revision. Cox proportional hazard regression and Kaplan-Meier curves were used for the analyses. The incidence for post-transplant de novo malignancy in the tourist group was 1.8-fold higher than that of the domestic group (21.8 vs 12.1 per 1000 person-years). The overall cancer recurrence rate was approximately 11%. The top 3 post-transplant malignancies, in decreasing order, were urinary tract, kidney, and liver cancers, regardless of the recipient type. Compared with domestic recipients, there was significant higher mortality risk in transplant tourists (adjusted hazard ratio = 1.2, 95% confidence interval: 1.0-1.5). In addition, those with either pre-transplant or post-transplant malignancies were associated with increased mortality risk. We suggest that a sufficient waiting period for patients with pre-transplant malignancies should be better emphasized to eliminate recurrence, and transplant tourists should be discouraged because of the possibility of higher post-transplant de novo malignancy occurrence and mortality.
authors.affiliation: From the Division of Nephrology (M-CC, M-JW, T-MY, K-HS), Department of Medicine, Taichung Veterans General Hospital; School of Medicine (M-JW), Chung Shan Medical University; Department of Urology (C-HC); Department of Medicine (C-HC, C-HM), College of Medicine; Management Office for Health Data (C-HM), China Medical University and Hospital; Division of Urology (H-CH), Department of Surgery, Taichung Veterans General Hospital; Department of Health Risk Management (C-JC), College of Public Health, China Medical University; and Department of Medical Research (C-JC), China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Mu-Chi
authors.initials: MC
authors.lastname: Chung
authors.forename: Ming-Ju
authors.initials: MJ
authors.lastname: Wu
authors.forename: Chao-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.forename: Tung-Min
authors.initials: TM
authors.lastname: Yu
authors.forename: Hao-Chung
authors.initials: HC
authors.lastname: Ho
authors.forename: Kuo-Hsiung
authors.initials: KH
authors.lastname: Shu
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D057193:Medical Tourism / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult