Patients who travel to China for kidney transplants are at a higher risk of posttransplant malignancy, reports a study in Kidney International.
Long-term complications were reviewed for two groups of Taiwanese patients: 215 transplant tourists who traveled to China and 321 patients who underwent kidney transplantation at a Taiwan university hospital. The transplants were performed from 1987 through 2006. The transplant tourists were older than the domestic transplant patients: 46 versus 40 years.
At 10 years’ follow-up, graft survival rates were 55 percent for the transplant tourists and 60 percent for the domestic transplant group. The patient survival rates were 81.5 and 89.3 percent, respectively; the between-group differences were not significant.
However, the 10-year cumulative cancer incidence was 21.5 percent for the transplant tourists compared with 6.8 percent in the domestic group. In stepwise regression analyses that excluded time during immunosuppressive therapy—an uncontrollable factor—the incidence of cancer was significantly higher for the transplant tourists. Patients who were older at the time of transplant were at higher risk of cancer, although the risk of de novo cancer decreased with longer graft survival.
Over the objections of the transplant community, patients continue to travel to foreign countries for kidney transplants. In China, such transplant tourists can receive commercial renal transplants from executed prisoners.
This long-term retrospective study finds a higher rate of posttransplant malignancy in Taiwanese patients who travel to China for kidney transplants, compared with domestic kidney recipients. This risk appears to be greater for older recipients. Other contributing factors may include increased depleting antibody induction therapy and omission of pretransplant cancer screening [Tsai M-K, et al. De novo malignancy is associated with renal transplant tourism. Kidney Int 2011; 79:908–913].