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Changes in Tuberculosis Risk after Transplantation with Decreased Community Tuberculosis Incidence: A National Population-Based Study, 2008–2020
29 Pages Posted: 23 Jun 2023
More...Abstract
Transplant recipients are immunocompromised and vulnerable to developing tuberculosis. To evaluate the risk of developing active tuberculosis after transplantation, risk factors for tuberculosis and standardized incidence rates were compared with those in the general population.This retrospective study was conducted based on the South Korean health insurance review and assessment database among those underwent transplantation (62,484 recipients) between 2008 and 2020. Tuberculosis incidence was compared in recipients treated during higher (2010–2012) and lower disease burden (2016–2018) periods. Standardized incidence ratios were analyzed using the Korean Tuberculosis Surveillance System. The primary outcome was the number of new tuberculosis cases after transplantation.Of 57,103 recipients analyzed, the overall cumulative incidence rate one year after transplantation was 0⸱8% (95% confidence interval [CI] = 0⸱7–0⸱8)—significantly higher in the higher-burden than in the lower-burden period (1⸱7% vs. 1⸱0% three years after transplantation, P <0⸱001). Allogeneic hematopoietic stem cell transplantation had the highest tuberculosis incidence, followed by solid organ transplantation and autologous hematopoietic stem cell transplantation (P <0⸱001). The overall standardized incidence ratio was 3⸱9 (95% CI = 3⸱7–4⸱2) and was highest in children aged 0–19, at 9⸱0 (95% CI = 5⸱7–13⸱5). Male sex, older age, tuberculosis history, liver transplantation, and allogeneic hematopoietic stem cell transplantation were risk factors for tuberculosis.Transplant recipients are vulnerable to developing tuberculosis, possibly affected by immunocompromised status, solid-organ transplant type, age, and community prevalence. Tuberculosis prevalence by country, transplant type, and age should be considered to establish an appropriate tuberculosis prevention strategy for high-risk groups.
Funding: This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education [grant number 2019R1A6A1A03032869] and by the Ministry of Science and ICT [grant number NRF-2020R1G1A1005010].
Declaration of Interest: The authors of this manuscript have no conflicts of interest to disclose.
Ethical Approval: This study was reviewed and approved by the Institutional Review Board of Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Reg. No. 4-2020-0018). The requirement for informed consent was waived owing to the use of anonymous data.
Keywords: Solid organ transplantation, Hematopoietic stem cell transplantation, Tuberculosis, Community tuberculosis burden, Standard incidence ratio
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