Kidney transplantation in patients travelling from the UK to India or Pakistan.

Sir, There is a shortage of kidneys for cadaver transplantation in the UK, and an allocation policy that disadvantages Indo-Asian subjects [1]. This has led some patients to travel abroad for transplantation. Previous reports of this practice indicate high complication and graft failure rates [2–5]. Since 1996, nine patients from our transplant list have travelled overseas for transplantation. One went to China, and no more has been heard. Five went to India and three to Pakistan. One patient received two transplants, giving nine transplants in eight patients. The outcomes in the first year after transplantation are shown in Table 1, compared with the outcomes of 30 living donor transplants performed in our unit between 1996 and 2001. There were two deaths and a graft failure in the India and Pakistan group, compared with one death and one graft failure in Coventry, UK (68% survival rate in India and Pakistan, 92% in Coventry). Serious complications occurred more frequently in patients transplanted in India and Pakistan than in Coventry, eight complications in six patients and 11 complications in 28 patients, respectively (Table 1). Serious complications were defined as contracting hepatitis B or C, or requiring readmission to hospital other than for diagnosis and management of suspected rejection. One patient died of infection in India, although the details of causation (bacterial, fungal or malaria) are not known to us. The patients transplanted in Coventry and Asia were not fully comparable. However, there were high-risk patients in both groups. Two patients who went to India were suspended from our transplant list for medical reasons. In Coventry, one patient had a previous heart–lung transplant and two transplants were performed urgently in patients judged to have a low chance of survival on dialysis (widespread vascular thrombosis and another with repeated critical care admissions for septicaemia). Induction immunosuppression was tacrolimus based in two cases and cyclosporin based in four others from India and Pakistan. Two cases had anti-interleukin 2 receptor monoclonal antibody treatment. In Coventry, 16 patients received cyclosporin-based immunosuppression and 14 tacrolimus-based immunosuppression. There was no difference in the incidence of acute rejection between groups. The outcomes for the overseas donors could not be fully assessed. One donor had a horseshoe kidney with four arteries. The whole organ was removed, split into two parts, and then one part transplanted back into the donor. One recipient had a transplant biopsy performed in the UK that showed a …