International travel and exposure risks in solid-organ transplant recipients

Background. Although solid-organ transplant recipients (SOTR) have an increased risk of acquiring illnesses, they may not receive optimal pretravel care. We conducted a cross-sectional survey of travel activities and outcomes among SOTR. Methods. Two thousand five hundred fifty-four consecutive living SOTR from Mayo Clinic were surveyed regarding travel practices, pretravel counseling, exposure risks, and illness using a previously standardized and validated questionnaire. Results. One thousand one hundred thirty SOTR (44%) responded to the survey and were included in the Study. The most common transplanted organs were liver (519 patients) and kidney (515 patients). Three hundred and three (27%) respondents reported travel outside of the United States or Canada after their transplant. Liver recipients were more likely to travel than other organ recipients. Ninety-six percent of travelers reported that they did not seek specific pretravel healthcare before their trip. Forty-nine SOTR (16%) traveled to destinations at higher risk for infectious diseases; travelers to these destinations were more likely to be men (73% vs. 54% of low-infection risk travelers, P=0.018) or born outside the United Stated or Canada (29% vs. 6% P<0.0001). Twenty-four travelers (8%) required medical attention because of illness; illness was more likely among travelers to high-infection risk (18%) than low-risk (6%) destinations, P=0.004. Conclusions. International travel was common after solid organ transplantation, although the majority traveled to destinations at low risk for infectious disease. Although generally SOTR were able to travel safely, travelers to destinations at high-risk for infection had a significant rate of illness. Pretravel counseling and interventions were infrequent and should be improved.