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The landscape of international living kidney donation in the United States
Author(s) -
Al Ammary Fawaz,
Thomas Alvin G.,
Massie Allan B.,
Muzaale Abimereki D.,
Shaffer Ashton A.,
Koons Brittany,
Qadi Mohamud A.,
Crews Deidra C.,
GaronzikWang Jacqueline,
Fang Hai,
Brennan Daniel C.,
Lentine Krista L.,
Segev Dorry L.,
Henderson Macey L.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15256
Subject(s) - medicine , kidney donation , donation , cohort , kidney transplantation , transplantation , demography , economic growth , sociology , economics
In the United States, kidney donation from international (noncitizen/nonresident) living kidney donors (LKDs) is permitted; however, given the heterogeneity of healthcare systems, concerns remain regarding the international LKD practice and recipient outcomes. We studied a US cohort of 102 315 LKD transplants from 2000‐2016, including 2088 international LKDs, as reported to the Organ Procurement and Transplantation Network. International LKDs were more tightly clustered among a small number of centers than domestic LKDs (Gini coefficient 0.76 vs 0.58, P < .001). Compared with domestic LKDs, international LKDs were more often young, male, Hispanic or Asian, and biologically related to their recipient ( P < .001). Policy‐compliant donor follow‐up was substantially lower for international LKDs at 6, 12, and 24 months postnephrectomy (2015 cohort: 45%, 33%, 36% vs 76%, 71%, 70% for domestic LKDs, P < .001). Among international LKDs, Hispanic (aOR = 0.23 0.36 0.56 , P < .001) and biologically related (aOR = 0.39 0.59 0.89 , P < .01) donors were more compliant in donor follow‐up than white and unrelated donors. Recipients of international living donor kidney transplant (LDKT) had similar graft failure (aHR = 0.78 0.89 1.02 , P = .1) but lower mortality (aHR = 0.53 0.62 0.72 , P < .001) compared with the recipients of domestic LDKT after adjusting for recipient, transplant, and donor factors. International LKDs may provide an alternative opportunity for living donation. However, efforts to improve international LKD follow‐up and engagement are warranted.