Tuberculosis after solid-organ transplant: incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort.
BACKGROUND
It is necessary to clarify the incidence of and risk factors for tuberculosis (TB) among solid-organ transplant (SOT) recipients as well as changes in the chronology, clinical presentation, and prognosis of the disease.


METHODS
A total of 4388 SOT recipients were monitored prospectively at 16 transplant centers included in the Spanish Network for Research in Infectious Diseases (REIPI). TB episodes were studied, and the incidence rate was calculated. Certain variables were analyzed, by Cox regression analysis, as potential risk factors for TB.


RESULTS
Among the 4388 SOT recipients, 21 cases of TB were reported (0.48%). The median duration of follow-up was 360 days (range, 0-720 days). The global incidence of TB was 512 cases per 10(5) patients per year (95% confidence interval [CI], 317-783), which was higher than that in the general population in Spain (18.9 cases per 10(5) inhabitants per year; relative risk [RR], 26.6). The highest incidence (2072 cases per 10(5) patients per year; 95% CI, 565-5306) was observed among lung transplant recipients (RR, 73.3). Of the TB cases, 95% occurred within the first year after transplant, and 76% were pulmonary forms. Crude mortality was 19.0%, and attributable mortality was 9.5%. Multivariate analysis identified recipient age (RR, 1.05; 95% CI, 1.0-1.1) and receipt of a lung transplant (RR, 5.6; 95%, 1.9-16.9) as independent risk factors.


CONCLUSIONS
TB incidence is increased among SOT recipients. The risk factors identified were age and receipt of a lung transplant. TB-attributable mortality (9.5%) is still high.
Torre-Cisneros
Julián
J
Clinic Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Avda. Menééndez Pidal, Córdoba 14004, Spain. julian.torre.sspa@juntadeandalucia.es
Doblas
Antonio
A
Aguado
José María
JM
San Juan
Rafael
R
Blanes
Marino
M
Montejo
Miguel
M
Cervera
Carlos
C
Len
Oscar
O
Carratala
Jordi
J
Cisneros
José Miguel
JM
Bou
Germán
G
Muñoz
Patricia
P
Ramos
Antonio
A
Gurgui
Merce
M
Borrell
Nuria
N
Fortún
Jesus
J
Moreno
Asunción
A
Gavalda
Joan
J
D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology*