Background:

Patients who receive organ transplants via transplant tourism may have a greater risk of complications. We sought to describe the infectious risks associated with this practice.

Methods:

This study was conducted at a large academic North American transplant center, and included cases of transplant tourism between the years 2001 and 2013. Transplant tourism was operationally defined as an individual living in North America travelling abroad to obtain a transplant. Patients were followed to 1 year post-transplant.

Results:

Of 4835 transplants performed at the center, we identified 71 cases of transplant tourism. Of these, 71.8% patients were men and median age was 51 years (range 22-74). The most common countries for transplantation were: Pakistan (26.7%), China (25.3%), India (11%), and Iran (5.6%). The organs transplanted were kidney (86%) and liver (14%). Donors were living (64%) or deceased (14%) although donor type was unknown in 22% of cases. A lack of information healthcare practitioners receive when patients travel abroad for transplantation was noted as a prevalent problem. Induction immunosuppression was unknown in 70% of patients and there was no information on perioperative antibiotics in 90% of cases. CMV donor serostatus was unknown in 95.7% patients.

During the first year post-transplant, 17% of patients had an episode of rejection and 63% had at least one episode of infection. The most common pathogens were bacterial (54.7%), and included ESBL E. coli, Mycobacterium tuberculosis, Campylobacter sp., and Burkholderia cepacia. Viral pathogens accounted for 35.8% of the reported infections and included Cytomegalovirus, Epstein-Barr virus, and BK polyomavirus. Parasitic and fungal pathogens accounted for 3.8% and 1.9% of reported infections respectively. The most common locations of infection were the urinary tract (55%, 25/45), transplant wound (11%, 5/45), pulmonary (11%, 5/45), gastrointestinal (8.9%, 4/45), and skin/soft tissue (8.9%, 4/45). No cases of donor derived HIV, HCV or HBV were observed. One year mortality was 2.8%.

Conclusion:

Transplant tourism is an ongoing issue in North America and will likely continue as long as the organ shortage persists. We found that patients return with limited donor and peri-transplant management information. High rates of infectious complications were observed often with drug resistant organisms.

CITATION INFORMATION: Slomovic J., Humar S., Kumar D., Humar A. Prevalence and Infection-Related Outcomes Associated with Transplant Tourism Am J Transplant. 2017;17 (suppl 3).

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