Undocumented immigrants' transplant survival rates on par with US citizens'

September 20, 2019

Unauthorized immigrants who receive liver transplants in the United States have comparable three-year survival rates to U.S. citizens, according to a study by researchers at UC San Francisco. Yet access to life-saving organs for this population varies widely by state, in part due to a medical misperception that undocumented migrants face a higher risk of transplant failure.

The findings appeared online Sept. 20, 2019, in Hepatology.

"Our results bring much-needed scientific evidence to a politically and medically divisive issue and shed light on disparities due to policy and provider attitudes," said corresponding author Brian P. Lee, MD, MPH, a gastroenterology and hepatology fellow at UCSF. "This could have considerable implications for the estimated 6,500 unauthorized immigrants in the United States who have end-stage renal disease and also may be relevant for other organ-transplant patients. We hope this will prompt appropriate action on national transplant policy."

An estimated 11 million foreign-born, non-citizens reside illegally in the United States and generally pay Social Security taxes. They account for about 3 percent of all deceased organ donors, but less than 0.5 percent of the recipients.

The United Network of Organ Sharing (UNOS) has no guidelines regarding liver transplant access for unauthorized immigrants, leaving transplant centers to establish their own policies. In 2012, UNOS began requiring liver transplant centers to record patients' citizen and residency status to better understand transplant tourism. Federal and state legislation also has been introduced that proposes specifically limiting organ transplant access for unauthorized immigrants. However, studies of this population group are sparse, partly due to difficulties identifying patients in medical registries.

In the Hepatology study, Lee and Norah Terrault, MD, MPH, a former UCSF professor of medicine who is now at the University of Southern California (USC), reviewed UNOS records of all U.S. liver transplant recipients between March 2012 and December 2018. They used Pew Research Center data to estimate the population of unauthorized immigrants in each state and by country of origin.

Of 43,192 recipients, 99.6 percent (43,026) were U.S. citizens and 0.4 percent (166) were unauthorized immigrants. The most common countries of origin were Mexico (52 percent), Guatemala (7 percent), China (6 percent), El Salvador (5 percent) and India (5 percent), rates similar to that of the overall U.S. immigrant population.

Compared to U.S residents, unauthorized immigrants were younger (49 years old vs. 58 years old), more frequently Hispanic (59 percent vs. 14 percent) and Asian (16 percent vs. 4 percent), had high school or below as the highest level of education (62 percent vs. 45 percent), and were covered by Medicaid (51 percent vs. 14 percent). They also were sicker, with a higher transplant score, and more likely to be on dialysis (31 percent vs. 15 percent), which suggests access to transplant late into their disease, Lee said.

Most transplants for these patients occurred in California (78 patients, 47 percent) and New York (30 patients, 18 percent), roughly twice their representation in the local populations (27 percent in California, 7 percent in New York), and almost a quarter of them occurred at USC (31) and UCSF (10). By contrast, the proportion of liver transplants for unauthorized immigrants was lower than their relative populations in Texas and Florida, highlighting a disparity in access across the country, Lee said. These differences corresponded to states favoring or resisting Medicaid expansion for transplant coverage.

A risk analysis found similar graft and patient survival rates for unauthorized immigrants as U.S. citizens, with one- and three-year survival rates of 95 percent and 88 percent, respectively, in unauthorized immigrants and 92 percent and 85 percent among residents.

"Given these findings of acceptable survival outcomes among unauthorized immigrants, concern for worse survival should not be used as a reason to deny access to liver transplant," Lee said. "Continued financial support after transplant also can be a barrier in this group, but those means are confirmed beforehand and also not a reason for denial."
Funding was provided by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (P30DK026743, T32DK060414). The authors report no conflicts of interest.

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. Learn more at https://www.ucsf.edu, or see our Fact Sheet.

University of California - San Francisco

Related Liver Transplant Articles from Brightsurf:

Advanced liver disease patients and transplant recipients need specific care during COVID-19
The European Association for the Study of the Liver (EASL) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) have issued a Position Paper, providing recommendations for clinicians caring for patients with liver diseases during the current pandemic.

Certain liver cells may help prevent organ rejection after transplant, study finds
Mesenchymal stromal cells from fat tissue and bone marrow are widely used in therapeutic trials for their anti-inflammatory qualities, but new Mayo Clinic research finds that liver cells may be of greater value.

University of Cincinnati finds new option for liver transplant patients
Budesonide, a drug commonly used to treat Crohn's Disease, may offer fewer side effects and work at least as well as prednisone as an anti-organ rejection medication in liver transplant patients.

Cleveland clinic's first purely laparoscopic living donor surgery for liver transplant
Cleveland Clinic has successfully performed the Midwest's first purely laparoscopic living donor surgery for liver transplantation in an adult recipient.

Alcohol relapse rate among liver transplant recipients identical regardless of sobriety period
For decades, patients with liver disease related to alcohol use have been told they must be sober for six months before they can get a liver transplant.

Why liver transplant waitlists might misclassify high-risk patients
A new study in the journal Gastroenterology reveals that the standard method for ranking patients on the waitlist for lifesaving liver transplantation may not prioritize some of the sickest candidates for the top of the list.

Liver transplant for alcohol-related liver disease in US
The proportion of liver transplants in the United States for alcohol-associated liver disease increased between 2002 and 2016, with much of the increase associated with a decrease in liver transplant for hepatitis C virus infection because of antiviral therapy.

African-Americans may live longer after liver transplant if their donors are the same race
African-American adults undergoing liver transplant to treat liver cancer lived significantly longer if their organ donor was also African-American.

Liver transplant survival rate sees improvement among older adults
To learn more about older adults and liver transplants, a team of researchers studied information recorded by the Scientific Registry of Transplant Recipients (SRTR) from 2003 to 2016.

Anticancer drug offers potential alternative to transplant for patients with liver failure
Patients suffering sudden liver failure could in the future benefit from a new treatment that could reduce the need for transplants, research published today shows.

Read More: Liver Transplant News and Liver Transplant Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.