WH LIM1,2, SP MCDONALD2,3, G WONG4, J KANELLIS5, D MARTIN6, PT COATES3,
1 Sir Charles Gairdner Hospital, Perth; 2 ANZDATA Registry, Adelaide; 3 Royal Adelaide Hospital, Adelaide; 4 Westmead Hospital, New South Wales; 5 Monash Medical Centre, Melbourne; 6 Faculty of Health, Deakin University, Melbourne
Aim: To compare the long-term allograft and patient outcomes of recipients who have received a kidney transplant locally or overseas.
Background: Disparities in health outcomes after kidney transplantation exist by countries. However, graft and patient outcomes among those who were transplanted overseas but managed locally have not been studied.
Methods: Using data from ANZDATA registry, primary live and deceased donor kidney transplant recipients between 1990-2014 were included. Associations between overseas transplants (i.e. kidney transplants that occurred outside of Australia or New Zealand), overall graft loss and all-cause mortality were examined using adjusted Cox regression analysis.
Results: Of 16,074 kidney transplant recipients, 236 (1.5%) received their transplants overseas. The proportion of overseas transplants has declined from 2.7% of overall transplants between 2002-2007 to 0.7% between 2008-2014 (p<0.001). China was the most commonly reported overseas transplant country (33%), followed by India/Pakistan (16%). Data relating to donor characteristics and HLA-matching were not available in over 90% of overseas transplants. Compared to recipients of local transplants, overseas recipients were more likely to be non-caucasian/non-indigenous (63% vs. 13%, p<0.001), more likely to have received unrelated live-donor kidney transplants (28% vs. 4%, p<0.001) and have experienced a shorter mean (SD) waiting time (1.5 [1.8] vs. 2.5 [2.5] years, p<0.001). The adjusted HR for overall graft loss and all-cause mortality among overseas transplant recipients were 0.62 (95%CI 0.48, 0.81) and 0.71 (95%CI 0.51, 1.00), respectively. Conclusions: The majority of the overseas kidney transplants occurred in Asia, with graft and patient survivals comparable to local transplants. However, complete data capture for overseas transplants are poor and it is likely that these transplants and related outcomes may have been underreported to the registry.