Abstract 13445: Patterns and Outcomes of Thoracic Organ Transplantation Across Citizenship Status in the United Status

Abstract

Introduction: The volume of solid organ transplantation in the US has increased in recent years. Few data are available characterizing thoracic transplantation patterns and outcomes by citizenship status. Methods: Citizenship at the time of transplantation was characterized among thoracic organ transplantation recipients in the US between 2013 and 2018 using United Network for Organ Sharing data. The non-US citizen group included non-US citizen/US residents, non-US citizen/non-US residents who travelled to the US for transplantation, and non-US citizen/non-US residents who travelled to the US for reasons other than transplantation. Cox regression models were constructed to examine the association between citizenship status and death or graft failure, accounting for age, sex, race, and payment method. Results: Among 31,174 thoracic organ transplantations, number of non-US citizen thoracic organ recipients increased from 90 in 2013 to 221 in 2018 (a 146% increase). Proportion of non-US citizen recipients (of all recipients) similarly increased from 2.0% in 2013 to 3.7% in 2018 (Figure 1a). Non-US citizens were, on average, younger than US citizens (46±19 vs 51±19 years, p<0.001) and were less likely to be supported by Medicaid (13% vs. 22%, p<0.001). By 6 months, there were 2,228 deaths or graft failures, which similarly occurred among non-US citizens and US-citizens (6.1% vs 6.8%, P=0.38) (Figure 1b). Non-US citizens did not experience higher covariate-adjusted risk of post-transplant death or graft failure compared with US citizens (adj. HR 0.93; 95% CI 0.70-1.25; P=0.64). Conclusions: Between 2013 and 2018, there was a modest increase in non-US citizen recipients of thoracic organ transplantation. Non-US citizens have similar risk-adjusted patient and graft survival when undergoing thoracic organ transplantation compared with US citizens.