Undocumented immigrants experience similar kidney transplant results to residents
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Kidney transplant outcomes among undocumented immigrants in California are similar to that of U.S. residents, according to data published in JAMA Network Open.
However, undocumented immigrants are not able to receive the same kidney care as U.S. residents in the entire country. Researchers of this study recommend extending transplant access to undocumented immigrants to improve end-stage kidney disease outcomes.
“[A]ccess to maintenance dialysis and [kidney transplantation] for [undocumented immigrants] is dependent upon state legislation. California is one of the few states that use state 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]here still is an overbearing, long-held perception that [undocumented immigrants] have worse transplant outcomes due to financial and social issues. Kidney transplant outcome among [undocumented immigrants] in California, where there is the highest number of [undocumented immigrants], has not been evaluated yet.”
In a retrospective cohort study, researchers examined data for 446 kidney transplant recipients from the University of California, Irvine, between Jan. 1, 2012, and Sept. 1, 2019.
Patients who were undocumented immigrants were defined as immigrants living in the U.S. without legal documentation or permission (n=114), whereas patients living in the U.S. with documentation were defined as U.S. residents (n=332).
With citizenship status serving as the exposure, researchers considered all-cause graft loss to be the primary outcome. Using Cox proportional hazard regression analyses, researchers compared all-cause mortality between undocumented immigrants and U.S. residents. Moreover, researchers performed competing risk regressions with mortality and mortality with graft loss as competing risks to determine other transplant outcomes.
After a median follow-up of 3.39 years, six undocumented immigrants experienced all-cause graft loss, as did 48 U.S. residents. Researchers observed a 192% and 343% increased unadjusted risk for all-cause graft loss and all-cause mortality among U.S. residents during the study period. However, researchers concluded these findings 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, researchers did not identify any difference in incidence rate of kidney allograft rejection between undocumented immigrants and U.S. residents in California. However, as mentioned previously, kidney care is not as accessible to undocumented immigrants across the states as it is in California. Researchers recommend extending access throughout the country to improve ESKD outcomes.
“Granting maintenance dialysis and [kidney transplant] access to all ESKD patients is not only essential to provide ESKD patients with better outcomes, but to also reduce the cost of ESKD treatment. In 2019, the total Medicare spending on the treatment of ESKD patients totaled $35.9 billion, accounting for 7.2% of the overall Medicare-paid claims in the fee-for-service system,” Eguchi and colleagues wrote. They added, “[I]ndividual states and the nation as a whole would save substantial taxpayer dollars by granting undocumented immigrants access to [kidney transplantation]. Despite these benefits, in most states, [undocumented immigrants] are still denied these better ESKD treatment options. The reasons are unclear but likely arise from several factors contributing to the perception regarding worse transplant outcomes. In addition, social determinants of health may lead to this disparity to transplant access.”
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