Liver Transplantation in Foreign Nationals: Lower Rates of Waitlist Mortality and Higher Rates of Lost to Follow-Up Post-Transplant
University of Pennsylvania, Philadelphia.
Meeting: 2018 American Transplant Congress
Abstract number: C217
Keywords: Ethics, Waiting lists
Session Information
Session Name: Poster Session C: Liver: Recipient Selection
Session Type: Poster Session
Date: Monday, June 4, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background: A highly contentious issue in the transplant community is whether or not to provide deceased donor liver transplant (DDLT) to non-citizen/non-residents (NCNRs) who travel for liver transplant (LT) and pay out of pocket. There are no formal caps on the number of NCNR LTs, but the expectation is that access to LT and follow-up would mirror that of other patients. This has never been formally assessed.
Methods: UNOS data from 2/27/02-12/31/16 were used to identify NCNRs (foreign nationals who were not US citizens or residents) and compare to US citizens and residents (USCRs). All adults were included, except status 1 listings. Multivariable logistic regression was used to analyze waitlist outcomes, and competing risk analysis was used to assess rates of lost to follow-up post-LT.
Results: 1,260 NCNRs were listed for LT, representing 0.86% of listings. A higher number of NCNR listings were in UNOS regions 3, 5, and 7.
Adjusted probability of DDLT was not significantly different for NCNRs and USCRs (p>0.5), but NCNRs were significantly less likely to be removed from the waitlist for death or clinical worsening (aOR: 0.80, 95% CI: 0.69-0.93, p=0.003). In multivariable competing risk models among all LT recipients, NCNRs had an eleven-fold higher risk of being lost to follow up after accounting for the competing risk of death (SHR 11.44, 95% CI 8.72-15.01, p<0.001).
Conclusions: NCNRs waitlisted for LT have significantly lower risks of dying than USCRs. Despite similar transplant rates, there was a striking difference in the rate of lost to follow-up between NCNRs and USCRs. This raises issues regarding differences in post-LT care and potentially even criteria for listing given that expectations for follow-up should not differ based on a candidate's place of residence. Further data are needed to assess outcomes of NCNRs lost to follow-up.
CITATION INFORMATION: Ferrante N., Goldberg D. Liver Transplantation in Foreign Nationals: Lower Rates of Waitlist Mortality and Higher Rates of Lost to Follow-Up Post-Transplant Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Ferrante N, Goldberg D. Liver Transplantation in Foreign Nationals: Lower Rates of Waitlist Mortality and Higher Rates of Lost to Follow-Up Post-Transplant [abstract]. https://atcmeetingabstracts.com/abstract/liver-transplantation-in-foreign-nationals-lower-rates-of-waitlist-mortality-and-higher-rates-of-lost-to-follow-up-post-transplant/. Accessed May 13, 2025.« Back to 2018 American Transplant Congress