Non-US Citizen Liver Transplant Recipients (LTR) Have Superior Outcomes Compared to US Citizen LTR: A Retrospective Study of 50,422 Subjects Using the Organ Procurement and Transplant Network (OPTN) from 1992-2015
1Department of Transplantation, Southern Illniois University School of Medicine, Springfield, IL
2Department of Abdominal Transplantation, Baylor, Houston, TX.
Meeting: 2018 American Transplant Congress
Abstract number: A275
Keywords: Allocation, Liver transplantation, Outcome
Session Information
Session Name: Poster Session A: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
The US performs over 7,000 liver transplants per year and a substantial subset of Non-US citizen recipients exist. United Network for Organ Sharing (UNOS) policy clearly defines “transplant tourism" and states that the non-resident recipients should not exceed 5% of the total number of transplants of any organ. Although not previously studied, organ shortage makes it imperative that Non-US citizen LTR are critically analyzed and compared to US LTR.
We retrospectively analyzed 50,422 LTR from 1992-2015 using the (OPTN). Using Multivariate Cox Regression and Kaplan-Meier (KM) methodology, we evaluated the association between US/Non-US citizenship and survival.
Significant predictors of survival included US citizenship (p<.001), and other co-variates of interest.
| HR w/ CI | p= | |
| Non-US Citizen | 0.78 (0.68-0.89) | .0001 |
| Race (white as reference) Black | 1.32 (1.24-1.40) | .0001 |
| Hispanic | 0.93 (0.88-0.99) | .022 |
| Other | 0.86 (0.78-0.94) | .0001 |
| Graft Cold Ischiemia Time | 1.01 (1.00-1.01) | .02 |
| Age of Donor | 1.01 (1.02-1.01) | .0001 |
| Male Gender | 1.10 (1.06-1.15) | .0001 |
| +HCV in Recipient | 1.49 (1.44-1.56) | .0001 |
| Recipient Length of Stay | 1.01 (1.01-.1.01) | .0001 |
| Donor BMI | 0.99 (0.99-1.00) | .31 |
| Recipient MELD | 0.99 (0.99-0.99) | .0001 |
| PVT in Recipient | 1.15 (1.04-1.27) | .01 |
| Rejection in 1st Year post Transplant | 1.29 (1.23-1.36) | .0001 |
| Any Known Recipient Malignancy | 1.18 (1.09-1.28) | .0001 |
| Previous Transplant in Recipient | 1.23 (1.14-1.32) | .0001 |
| Dialysis Pre-Transplnat in Recipient | 1.18 (1.10-1.27) | .0001 |
| Mode of Payment (any insurence as reference) Cash | 0.72 (0.53-0.97) | .03 |
| Foreign Government | 1.07 (0.64-1.79) | .80 |
Non-US citizens have a 22% increase in patient survival when compared to US citizen recipients over time. (LogRank of KM curve p<.001)
Non-US citizen LTR show superior graft and patient survival when compared to US citizen recipients. We feel superior outcomes in Non-US liver recipients justify the current UNOS policy on transplanting these patients.
CITATION INFORMATION: Butler T., Rana A., Garfinkel M. Non-US Citizen Liver Transplant Recipients (LTR) Have Superior Outcomes Compared to US Citizen LTR: A Retrospective Study of 50,422 Subjects Using the Organ Procurement and Transplant Network (OPTN) from 1992-2015 Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Butler T, Rana A, Garfinkel M. Non-US Citizen Liver Transplant Recipients (LTR) Have Superior Outcomes Compared to US Citizen LTR: A Retrospective Study of 50,422 Subjects Using the Organ Procurement and Transplant Network (OPTN) from 1992-2015 [abstract]. https://atcmeetingabstracts.com/abstract/non-us-citizen-liver-transplant-recipients-ltr-have-superior-outcomes-compared-to-us-citizen-ltr-a-retrospective-study-of-50422-subjects-using-the-organ-procurement-and-transplant-network-optn-f/. Accessed May 9, 2025.« Back to 2018 American Transplant Congress