*Purpose: Organ shortage has prompted UK residents to source organs overseas. Little is known about the circumstances in which these transplants take place, but stories of corruption and exploitation are widespread. In 2009 we reported data on UK residents who traveled overseas to receive a kidney transplant and returned to the UK for follow-up. We highlighted the inferior graft survival of those transplanted overseas compared with those transplanted in the UK and speculated how this may relate to the circumstances in which they were transplanted. Since that time professional guidelines and a Council of Europe National Focal Point initiative with key actions/indicators to help professionals and authorities identify illegitimate travel for transplant have been implemented. Here we report an updated summary of UK data.

*Methods: Follow-up data were obtained on all kidney transplants performed overseas between 01/01/00 and 31/12/16.

*Results: Between 2000-2016 n=396 (n=351 living donor, n=28 deceased donor, n=17 donor unspecified) kidney transplants took place overseas predominantly in Pakistan n=171(43%) and India n=63(16%). Of these only n=74(20%) have taken place since 2009. Transplants were predominantly from living unrelated donors n=206(52%). Of those from living related donors n=118(28%) the majority were recorded as cousins. Transplant recipients were predominantly male n=252(59%) and of Asian ethnicity n=219(59%). The mean age of recipients transplanted overseas was 44.8 years (range 15-83 years). 3 and 5-year outcome data for kidney transplants performed overseas and in the UK are set out in Table 1. Risk-adjusted Cox proportional hazards model conditional on 1-year survival and adjusted for donor type, recipient age, primary renal disease, recipient ethnicity and year of graft. For those patients who return and are reported, there is a significant difference in terms of five-year graft and patient survival compared with patients transplanted in the UK. Table 1: 3 and 5 year graft and patient survival in kidney transplants performed overseas and in the UK between 01/01/00-31/12/16

*Conclusions: Since 2009 there has been a significant reduction in overall numbers of UK residents transplanted overseas. However of those transplanted overseas graft survival and patient mortality rates remain significantly worse compared with those transplanted in the UK. Transplant units are encouraged to provide information to all patients considering traveling overseas to receive a transplant and report such transplants to NHS Blood and Transplant for further analyses.

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