title: Outcomes of Kidney Transplantation Abroad: A Single-Center Canadian Cohort Study.
abstract: BACKGROUND
  An increasing demand for kidney transplantation has enticed some patients with end-stage renal disease (ESRD) to venture outside their country of residence, but their posttransplant outcomes may be suboptimal.
  
  
  OBJECTIVE
  We compared the risks and clinical outcomes among tourists, or patients who pursue a kidney transplant abroad, versus patients who received a transplant at the Toronto General Hospital (TGH).
  
  
  METHODS
  A single-center, 1:3 matched (based on age at transplant, time on dialysis, and year of transplant) cohort study was conducted. Forty-five tourists were matched with 135 domestic transplant recipients between January 1, 2000, and December 31, 2011. Multivariable Cox proportional hazards models were fitted to assess graft and patient outcomes.
  
  
  RESULTS
  Among the 45 tourists, the majority (38 of 45) traveled to the Middle East or Far East Asia, and most received living donor kidney transplants (35 of 45). Multivariable Cox proportional hazards models showed that tourists had a higher risk for the composite outcome of acute rejection, death-censored graft failure, or death with graft function (DWGF; hazard ratio [HR] 2.08, 95% confidence interval [CI]: 1.06-4.07). Tourists also showed a higher risk for the individual end points of acute rejection, DWGF, and posttransplant hospitalizations.
  
  
  CONCLUSIONS
  Patients going abroad for kidney transplantation may have inferior outcomes compared to domestic patients receiving kidney transplants. Patients who are contemplating an overseas transplant need to be aware of the increased risk of adverse posttransplant outcomes and should be appropriately counseled by transplant professionals during the pretransplant evaluation process.
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Quach
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Heebah
authors.initials: H
authors.lastname: Sultan
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Olusegun
authors.initials: O
authors.lastname: Famure
authors.affiliation: Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada joseph.kim@uhn.ca.
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D002170:Canada; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control; D006085:Graft Survival; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D057193:Medical Tourism; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: adult; graft rejection; graft survival; humans; kidney transplantation; living donors; risk assessment; treatment outcome