Kidney transplant outcomes are no worse for undocumented immigrants than for US residents, a new study finds.

California uses state funds to provide undocumented immigrants with access to maintenance dialysis and kidney transplantation under their Medical Assistance Program. Among 446 patients receiving kidney transplants at the University of California, Irvine, from 2012 to 2019, 114 patients (25.6%) were undocumented immigrants. During a median 3.39 years, 6 undocumented immigrants and 48 US residents experienced graft loss.

In adjusted analyses excluding living donor kidney transplants, the risk for all-cause graft loss, death-censored graft loss, all-cause mortality, and acute rejection did not differ significantly between undocumented immigrants and US residents, Hirohito Ichii, MD, PhD, of the University of California, Irvine, and colleagues reported in JAMA Network Open.

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Deceased donor kidneys in the undocumented immigrant group had longer cold ischemic times. Undocumented immigrants were significantly less likely to undergo living donor kidney transplantation compared with US residents: 18% vs 30%.

“These findings suggest that extending kidney transplants to [undocumented immigrants] is safe and does not portend worse outcomes,” Dr Ichii’s team concluded. “As a result, denying transplant according to immigration status not only results in higher costs but also worse end stage kidney disease outcomes for an already underserved population.”

In an accompanying editorial, Aaron M. Delman, MD, MS, of the University of Cincinnati College of Medicine in Ohio, and colleagues wrote:

“We congratulate Eguchi and colleagues for demonstrating noninferior outcomes between undocumented immigrants and US residents after kidney transplantation. Their study highlights the outcomes that equitable policies and individual kidney transplant centers can have when they are committed to providing equitable access to care.”


Eguchi N, Tantisattamo E, Chung D, et al. Outcomes among undocumented immigrant kidney transplant recipients in California. JAMA Netw Open. Published online February 13, 2023. doi:10.1001/jamanetworkopen.2022.54660

Delman AM, Shah SA, Cuffy MC, et al. Equitable policies and center-level commitment may be associated with improved access to kidney transplantation for undocumented immigrants. JAMA Netw Open. Published online February 13, 2023. doi:10.1001/jamanetworkopen.2022.54666