Background:

Transplant tourism is defined as travel abroad for the express purpose of receiving or donating an organ. Post-operative complications including infections after transplant tourism may be significant. There are limited data with regards to infections in patients who travel abroad for the purpose of obtaining an organ for transplant.

Methods:

We reviewed infectious complications in patients from two transplant centers who specifically travelled to obtain an organ transplant outside of North America and Europe from 2002-2013. Outcomes were assessed to one year post-transplant.

Results:

57 charts of patients who had travelled for transplant were reviewed. Of these, 33 patients had an infectious episode post-transplant within one year of return. The majority of patients were men (66.7%) and median age was 51 (range 28-74) years. Transplant types were kidney (n=27) and liver (n=6). Of these, 23 were living donor, 5 were deceased donor, and 5 were unknown. Transplants were done in China (n=9), Pakistan (n=7), India (n=4), Iran (n=3), and other countries (n=10). Reasons for seeking transplant outside of North America included medical contraindication to transplant (n=2) and reduced wait time (n=5). Median time to infection from transplant was 54.5 days (range 0-336). Infections sites were urinary tract (n=13), transplant wound (n=5), pulmonary (n=3), skin/soft tissue (n=3) and other (n=9). Infection of multiple sites was present in 9 patients. In cases where microbiologic confirmation was available (n=29), bacterial infections were most common (72.4%). E. coli was the causative agent for 10 infections (8/10 were E.coli expressing extended-spectrum beta-lactamase (ESBL)). One patient developed tuberculosis. Other infections were viral (n=13) including new acquisition of Hepatitis B. Polymicrobial infections occurred in 8 patients. Outcome at day 30 post-infection included clearance of infection (18/28; 47.4%) and ongoing infection (10/28; 35.7%). At day 60, chronic infection was present in 8/27 (29.6%) and graft loss occurred in 1/27 (3.7%) patients.

Conclusion: The incidence of multi-drug resistant bacterial complications of transplant tourism is a significant risk factor for morbidity and mortality. Patients should be aware of infectious risks if they choose to pursue obtaining a transplant abroad.

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