TY - JOUR
T1 - The landscape of international living kidney donation in the United States
AU - Al Ammary, Fawaz
AU - Thomas, Alvin G.
AU - Massie, Allan B.
AU - Muzaale, Abimereki D.
AU - Shaffer, Ashton A.
AU - Koons, Brittany
AU - Qadi, Mohamud A.
AU - Crews, Deidra C.
AU - Garonzik-Wang, Jacqueline
AU - Fang, Hai
AU - Brennan, Daniel C.
AU - Lentine, Krista L.
AU - Segev, Dorry L.
AU - Henderson, Macey L.
N1 - Funding Information:
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Massie, Ms. Shaffer, Dr. Segev, and Dr. Henderson reported institutional grant support from the National Institutes of Health. No other disclosures were reported.
Funding Information:
This study was supported by the National Heart, Lung, and Blood Institute grant number HL007055 (Thomas) and the National Institute of Diabetes and Digestive and Kidney Diseases grant numbers F30DK116658 (PI: Shaffer), K01101677 (PI: Massie), 1K23DK115908‐01 (PI: Garonzik‐Wang), R01096008 (PI: Segev), K24DK101828 (PI: Segev), K01DK101677, K01DK114388 (PI: Henderson).
Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/7
Y1 - 2019/7
N2 - 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 = 0.230.360.56, P <.001) and biologically related (aOR = 0.390.590.89, 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 = 0.780.891.02, P =.1) but lower mortality (aHR = 0.530.620.72, 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.
AB - 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 = 0.230.360.56, P <.001) and biologically related (aOR = 0.390.590.89, 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 = 0.780.891.02, P =.1) but lower mortality (aHR = 0.530.620.72, 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.
KW - clinical research/practice
KW - donors and donation: donor follow-up
KW - kidney transplantation/nephrology
KW - kidney transplantation: living donor
KW - registry/registry analysis
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U2 - 10.1111/ajt.15256
DO - 10.1111/ajt.15256
M3 - Article
C2 - 30615253
AN - SCOPUS:85061272420
SN - 1600-6135
VL - 19
SP - 2009
EP - 2019
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -