PURPOSE: The disparity in access to organs for kidney transplantation has led to inter-state “transplant tourism.” Our objective was to determine if recipients traveling over a state line for kidney transplantation experience different outcomes relative to recipients native to that state.

METHODS: The Scientific Registry of Transplant Recipients was analyzed to examine all deceased donor kidney transplants performed from 1987-2014 at a single institution (n=1094). Those transplanted in their original state were labeled O (n=775). Those Nonnative recipients were labeled N (n=319).

RESULTS: Demographics:

Both sets of recipients received similar donor allografts except for the following (p-value<0.05):

The N group received more DCD (6.9% vs 3.1%, p=0.004) and CDC high-risk donors (19.4% vs. 7.6%, p<0.001), who were on average older (mean=36.7 vs. 34.2, p=0.016) and had a higher BMI (mean=26.8 vs 25.8, p=0.001). The N group had a shorter average cold ischemic time (mean=16.6 vs. 19.1 hours, p<0.001). However Donor KDPI median was not different between groups (38% vs 35%, p=0.478).

Recipient demographics:

The N group contained more Asians (5.6% vs 0.3%, p<0.001), an older population (mean=54.0 vs. 48.4, p<0.001) and fewer patients using Medicaid (0.7% vs 2.7%, p=0.042). The N group also had more patients with a current PRA higher than 20% (22.8% vs 17.5%, p=0.044) but fewer patients undergoing repeat transplantation (10.3% vs. 15.9%, P=0.018).

Outcomes:

Patient survival was not statistically significantly different (mean time in years=13.7 vs 12.9, p=0.707). However, the N group experienced less delayed graft function (13.3% vs. 20.9%, P=0.003), improved allograft survival (mean time in years=17.1 vs 12.9, p<0.05) and a lower rate of retransplantation (3.2% vs. 13%, P<0.001). Log Rank test showed a significant difference in graft survival between education levels (p=0.043). However, when analyzed with other possible risk factors in Cox Proportional Hazard test, education level was not an independent risk factor of graft failure (p=0.153).

CONCLUSIONS: In this single center study, those patients traveling from outside the state of transplantation (despite similar donor and recipient demographics) demonstrated superior allograft outcomes. These superior outcomes may be tied to socio-economic factors yet to be elucidated. Other confounding factors may exist to explain these discordant results.

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