title: Tuberculosis after solid-organ transplant: incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort.
abstract: 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.
authors.affiliation: Clinic Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Avda. Menééndez Pidal, Córdoba 14004, Spain. julian.torre.sspa@juntadeandalucia.es
authors.forename: Julián
authors.initials: J
authors.lastname: Torre-Cisneros
authors.forename: Antonio
authors.initials: A
authors.lastname: Doblas
authors.forename: José María
authors.initials: JM
authors.lastname: Aguado
authors.forename: Rafael
authors.initials: R
authors.lastname: San Juan
authors.forename: Marino
authors.initials: M
authors.lastname: Blanes
authors.forename: Miguel
authors.initials: M
authors.lastname: Montejo
authors.forename: Carlos
authors.initials: C
authors.lastname: Cervera
authors.forename: Oscar
authors.initials: O
authors.lastname: Len
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratala
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Cisneros
authors.forename: Germán
authors.initials: G
authors.lastname: Bou
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramos
authors.forename: Merce
authors.initials: M
authors.lastname: Gurgui
authors.forename: Nuria
authors.initials: N
authors.lastname: Borrell
authors.forename: Jesus
authors.initials: J
authors.lastname: Fortún
authors.forename: Asunción
authors.initials: A
authors.lastname: Moreno
authors.forename: Joan
authors.initials: J
authors.lastname: Gavalda
mesh_terms: 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*