Undocumented Immigrants Get Kidney Transplant Outcomes Similar to Residents

According to data published in JAMA network open.

However, undocumented immigrants cannot receive the same kidney care as US residents nationwide. The researchers in this study recommend expanding access to transplant to undocumented immigrants to improve outcomes for end-stage kidney disease.

“[A]access to maintenance dialysis and [kidney transplantation] For [undocumented immigrants] depend on state law. California is one of the few states to use public funds to provide [undocumented immigrants] with access to maintenance dialysis and [kidney transplantation]”, Natsuki Eguchi, BS, from the department of surgery at the University of California, Irvine, and colleagues wrote. “[T]there is still a prevailing and long-standing perception that [undocumented immigrants] have poorer transplant outcomes due to financial and social problems. Result of kidney transplant in [undocumented immigrants] in California, where there is the greatest number of [undocumented immigrants]has not yet been rated.

In a retrospective cohort study, researchers looked at data from 446 kidney transplant recipients at the University of California, Irvine, between January 1, 2012 and September 1, 2019.

Patients who were undocumented immigrants were defined as immigrants living in the US without papers or legal permission (n = 114), while patients living in the US with papers were defined as US residents ( n = 332).

With citizenship status serving as the exposure, the researchers considered all-cause graft loss as the primary outcome. Using Cox proportional hazard regression analyses, the researchers compared all-cause mortality between undocumented immigrants and US residents. Additionally, researchers performed competing risk regressions with mortality and graft loss mortality as competing risks to determine alternative transplant outcomes.

After a median follow-up of 3.39 years, six undocumented immigrants experienced all-cause graft loss, as did 48 US residents. The researchers observed a 192% and 343% increase in the unadjusted risk of all-cause graft loss and all-cause mortality among US residents over the study period. However, the researchers concluded that these results were insignificant and attenuated when adjusted for age and ethnicity. Additionally, the undocumented immigrants in this study were younger and had a lower prevalence of diabetes.

Overall, the researchers identified no difference in the incidence rate of kidney allograft rejection between undocumented immigrants and US residents in California. However, as mentioned earlier, kidney care is not as accessible to undocumented immigrants across the states as it is in California. The researchers recommend expanding access nationwide to improve ESKD outcomes.

“Grant maintenance dialysis and [kidney transplant] Access to all ESKD patients is not only essential to provide ESKD patients with better outcomes, but also to reduce the cost of ESKD treatment. In 2019, Medicare’s total expenditures for treating patients with ESKD totaled $35.9 billion, representing 7.2% of all Medicare-paid claims in the pay-as-you-go system. act,” Eguchi and his colleagues wrote. They added: “[I]Individual states and the nation as a whole would save taxpayers substantial dollars by granting undocumented immigrants access to [kidney transplantation]. Despite these advantages, in most states, [undocumented immigrants] are still denied these best ESKD treatment options. The reasons are unclear, but likely stem from several factors contributing to the perception of worse transplant outcomes. In addition, the social determinants of health may lead to this disparity in access to transplantation.