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Tsai DFC, Huang SW, Holm S, Lin YP, Chang YK, Hsu CC. The outcomes and controversies of transplant tourism-Lessons of an 11-year retrospective cohort study from Taiwan. PLoS One 2017; 12:e0178569. [PMID: 28575014 PMCID: PMC5456093 DOI: 10.1371/journal.pone.0178569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/15/2017] [Indexed: 12/18/2022] Open
Abstract
Background Transplant tourism has increased rapidly in the past two decades, accounting for about 10% of world organ transplants. However it is ethically controversial and discouraged by professional guidelines. We conducted this study to investigate the outcomes and trends of overseas kidney and liver transplantation in Taiwan to provide a sound basis for ethical reflection. Methods and findings The Taiwanese National Health Insurance Research Database was used to identify 2381 domestic and 2518 overseas kidney transplant (KT) recipients from 1998 to 2009 and 1758 domestic and 540 overseas liver transplantation (LT) recipients from 1999 to 2009. Cox proportional hazards models were used to assess the risks of mortality and graft failure. The numbers of overseas transplantation increased after 2000, reached a peak in 2005 and decreased after 2007. Compared to their domestic counterparts, the overseas KT recipients were older, male predominant, with shorter pre-op dialysis period and more comorbidities. Similarly, the overseas LT recipients were older, male predominant and had more hepatocellular carcinoma cases. The 1-, 5-, and 10-year patient survival rates were 96.9%, 91.7% and 83.0% respectively for domestic KT and 95.8%, 87.8% and 73.1% for overseas KT (p<0.001). The 1-, 5-, and 10-year patient survival rates were 89.2%, 79.5%, 75.2% for domestic LT and 79.8%, 54.7%, 49.9% for overseas LT (p<0.001). Conclusion The poorer outcomes of the overseas groups may be due to more older patients, more comorbidities (KT), or more hepatocellular carcinoma recurrences (LT). After domestic reform and international ethical challenges, the numbers of organ tourism decreased but the practice still persisted surreptitiously. Compulsory registration policies for overseas transplantation with international conventions to sanction organ trafficking and transplant tourism should be considered to stop these controversial practices.
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Affiliation(s)
- Daniel Fu-Chang Tsai
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine; Department of Medical Research, National Taiwan University Hospital; and Centre of Biomedical Ethics, National Taiwan University, Taipei, Taiwan
| | - Shi-Wei Huang
- Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Soren Holm
- School of Law, University of Manchester, Manchester, United Kingdom
| | - Yi-Ping Lin
- Office of Health Care Policy Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Yu-Kang Chang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Department of Medical Research, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- * E-mail:
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Lin YT, Wu PH, Kuo MC, Chen CS, Chiu YW, Yang YH, Lin MY, Hwang SJ, Chen HC. Comparison of dementia risk between end stage renal disease patients with hemodialysis and peritoneal dialysis--a population based study. Sci Rep 2015; 5:8224. [PMID: 25703589 PMCID: PMC4340159 DOI: 10.1038/srep08224] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/07/2015] [Indexed: 02/06/2023] Open
Abstract
A higher risk of dementia was reported in patients undergoing maintenance hemodialysis (HD) compared to those undergoing peritoneal dialysis (PD). Selection bias and competing risk of death were not considered in previous studies. The aim of this study was to investigate dementia risk in patients undergoing HD and PD by using the Taiwan Longitudinal Health Insurance Database. We enrolled 52,332 incident HD patients and 3292 incident PD patients who were older than 40 years between January 1, 1998 and December 31, 2007. During the study period, 3775 patients were diagnosed with dementia in the HD group (177.5 per 10,000 person-years incidence rate) and 181 patients in the PD group (145.9 per 10,000 person-years incidence rate). The results revealed that the higher hazard ratio of HD compared with PD for dementia disappeared after controlling for demographic characteristics, propensity score, and competing death risk (subdistribution hazard ratio was 1.086; 95% confidence interval, 0.940–1.255). In conclusion, HD did not increase the risk of dementia in dialysis-dependent patients compared to PD.
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Affiliation(s)
- Yi-Ting Lin
- 1] Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [2] Department of Public Health, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Hsun Wu
- 1] Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [2] Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- 1] Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [2] Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Sheng Chen
- 1] Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [2] Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Wen Chiu
- 1] Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [2] Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hsin Yang
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- 1] Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [2] Technology Research Center, National Applied Research Laboratories, Taiwan
| | - Shang-Jyh Hwang
- 1] Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [2] Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- 1] Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [2] Faculty of Renal Care, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chung MC, Wu MJ, Chang CH, Muo CH, Yu TM, Ho HC, Shu KH, Chung CJ. Increased risk of post-transplant malignancy and mortality in transplant tourists: a nationwide population-based cohort study in Taiwan. Medicine (Baltimore) 2014; 93:e344. [PMID: 25546686 PMCID: PMC4602598 DOI: 10.1097/md.0000000000000344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Information on post-transplant malignancy and mortality risk in kidney transplant tourists remains controversial and is an important concern. The present study aimed to evaluate the incidence of post-transplant malignancy and mortality risk between tourists and domestic transplant recipients using the claims data from Taiwan's universal health insurance. A retrospective study was performed on 2394 tourists and 1956 domestic recipients. Post-transplant malignancy and mortality were defined from the catastrophic illness patient registry by using the International Classification of Diseases, 9th Revision. Cox proportional hazard regression and Kaplan-Meier curves were used for the analyses. The incidence for post-transplant de novo malignancy in the tourist group was 1.8-fold higher than that of the domestic group (21.8 vs 12.1 per 1000 person-years). The overall cancer recurrence rate was approximately 11%. The top 3 post-transplant malignancies, in decreasing order, were urinary tract, kidney, and liver cancers, regardless of the recipient type. Compared with domestic recipients, there was significant higher mortality risk in transplant tourists (adjusted hazard ratio = 1.2, 95% confidence interval: 1.0-1.5). In addition, those with either pre-transplant or post-transplant malignancies were associated with increased mortality risk. We suggest that a sufficient waiting period for patients with pre-transplant malignancies should be better emphasized to eliminate recurrence, and transplant tourists should be discouraged because of the possibility of higher post-transplant de novo malignancy occurrence and mortality.
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Affiliation(s)
- Mu-Chi Chung
- From the Division of Nephrology (M-CC, M-JW, T-MY, K-HS), Department of Medicine, Taichung Veterans General Hospital; School of Medicine (M-JW), Chung Shan Medical University; Department of Urology (C-HC); Department of Medicine (C-HC, C-HM), College of Medicine; Management Office for Health Data (C-HM), China Medical University and Hospital; Division of Urology (H-CH), Department of Surgery, Taichung Veterans General Hospital; Department of Health Risk Management (C-JC), College of Public Health, China Medical University; and Department of Medical Research (C-JC), China Medical University and Hospital, Taichung, Taiwan
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Mamzer-Bruneel MF, Laforêt EG, Kreis H, Thervet É, Martinez F, Snanoudj R, Hervé C, Legendre C. Aspects éthiques de la transplantation rénale (donneurs et receveurs). Nephrol Ther 2012; 8:547-56. [DOI: 10.1016/j.nephro.2012.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Anker AE, Feeley TH. Estimating the risks of acquiring a kidney abroad: a meta-analysis of complications following participation in transplant tourism. Clin Transplant 2012; 26:E232-41. [DOI: 10.1111/j.1399-0012.2012.01629.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Ashley E. Anker
- Department of Communication; University of Buffalo; The State University of New York; Buffalo; NY; USA
| | - Thomas H. Feeley
- Department of Communication; University of Buffalo; The State University of New York; Buffalo; NY; USA
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Li WH, Chen YJ, Tseng WC, Lin MW, Chen TJ, Chu SY, Hwang CY, Chen CC, Lee DD, Chang YT, Wang WJ, Liu HN. Malignancies after renal transplantation in Taiwan: a nationwide population-based study. Nephrol Dial Transplant 2011; 27:833-9. [PMID: 21633099 DOI: 10.1093/ndt/gfr277] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Renal transplantation has been regarded as the treatment of choice for end-stage renal disease. Renal transplantation increases the risk of cancers due to long-term immunosuppression. The types of post-transplantation malignancies may vary among different geographic regions and ethnic populations. To date, large population-based studies of post-transplantation malignancies in Asian renal transplant recipients (RTRs) have rarely been reported. METHODS To investigate the patterns of post-transplantation malignancies in Chinese RTRs, we performed a nationwide population-based cohort study between 1997 and 2008 based on data from the National Health Insurance Database in Taiwan. Patterns of cancer incidence in RTRs were compared with those of the general population using standardized incidence ratios (SIRs). RESULTS Among the 4716 RTRs (2475 males and 2241 females; mean age 44.1 ± 12.4 years) and 22 556 person-years of observation, 320 post-transplant cancers were diagnosed. The SIR of all cancers was 3.75 (95% confidence interval 3.36-4.18). Women had a higher risk than men for the development of malignancies (SIR 5.04 for women and SIR 2.88 for men). Renal, bladder and liver cancers were the most common cancers, with SIRs of 44.29, 42.89 and 5.07, respectively. When stratified by age, RTRs of young age at transplant (<20 years) had the highest risk of post-transplantation malignancies. CONCLUSIONS This study demonstrates different patterns of malignancies after renal transplantation in Chinese RTRs, with higher incidences of kidney and bladder cancers. Physicians should be more vigilant in examining RTRs for post-transplantation malignancies especially in younger patients.
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Affiliation(s)
- Wei-Hsuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
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HSU CHIHCHENG, LEE CHENGHUA, HWANG SHANGJYH, HUANG SHIWEI, YANG WUCHANG, CHANG YUKANG, TSAI DANIELFUCHANG, KUO KENN. Outcomes of overseas kidney transplantation in chronic haemodialysis patients in Taiwan. Nephrology (Carlton) 2011; 16:341-8. [DOI: 10.1111/j.1440-1797.2010.01426.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen CH, Wen MC, Cheng CH, Wu MJ, Yu TM, Chuang YW, Shu KH. Infectious alopecia in a dog breeder after renal transplantation. J Chin Med Assoc 2008; 71:477-80. [PMID: 18818142 DOI: 10.1016/s1726-4901(08)70152-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Tinea capitis rarely occurs in renal transplant recipients. We report this living-related renal transplant patient receiving cyclosporine-based therapy who initially presented with severe exfoliation of the scalp with yellowish-white scales and marked hair loss. The lesions extended to the frontal area and both cheeks, resulting in several skin ulcers with perifocal erythematous inflammatory changes, and palpable cervical lymph nodes. A biopsy of a skin lesion revealed fungal infection and culture yielded Microsporum canis. The patient mentioned an outbreak of ringworm in her breeding dogs during this period. After adequate treatment of the patient and her infected animals with griseofulvin and disinfection of the environment, her skin lesions resolved dramatically, with regrowth of hair.
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Affiliation(s)
- Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
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