title: Commercial kidney transplantation is an important risk factor in long-term kidney allograft survival.
abstract: Transplant tourism, a form of transplant commercialization, has resulted in serious short-term adverse outcomes that explain reduced short-term kidney allograft survival. However, the nature of longer-term outcomes in commercial kidney transplant recipients is less clear. To study this further, we identified 69 Canadian commercial transplant recipients of 72 kidney allografts transplanted during 1998 to 2013 who reported to our transplant center for follow-up care. Their outcomes to 8 years post-transplant were compared with 702 domestic living donor and 827 deceased donor transplant recipients during this period using Kaplan-Meier survival plots and multivariate Cox regression analysis. Among many complications, notable specific events included hepatitis B or C seroconversion (7 patients), active hepatitis and/or fulminant hepatic failure (4 patients), pulmonary tuberculosis (2 patients), and a type A dissecting aortic aneurysm. Commercial transplantation was independently associated with significantly reduced death-censored kidney allograft survival (hazard ratio 3.69, 95% confidence interval 1.88-7.25) along with significantly delayed graft function and eGFR 30 ml/min/1.73 m(2) or less at 3 months post-transplant. Thus, commercial transplantation represents an important risk factor for long-term kidney allograft loss. Concerted arguments and efforts using adverse recipient outcomes among the main premises are still required in order to eradicate transplant commercialization.
authors.affiliation: Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: prasadr@smh.ca.
authors.forename: G V Ramesh
authors.initials: GVR
authors.lastname: Prasad
authors.affiliation: Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Sailesh
authors.initials: S
authors.lastname: Ananth
authors.affiliation: Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Sneha
authors.initials: S
authors.lastname: Palepu
authors.affiliation: Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Huang
authors.affiliation: Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Nash
authors.affiliation: Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Zaltzman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D003132:Commerce / Q000191:economics; D051799:Delayed Graft Function / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000191:economics / Q000379:methods / Q000401:mortality; D019520:Living Donors; D008297:Male; D057193:Medical Tourism / Q000191:economics; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: ethnicity; graft survival; transplant tourism