title: Impact of pulmonary and extrapulmonary tuberculosis infection in kidney transplantation: a nationwide population-based study in Taiwan.
abstract: BACKGROUND
  Tuberculosis (TB) has been reported to increase morbidity after kidney transplantation and pose a therapeutic challenge. However, population-based research, specifically focused on the association between kidney transplantation and subsequent pulmonary or extrapulmonary TB, is lacking.
  
  
  METHODS
  A nationwide population-based study was conducted using Taiwan's National Health Insurance Research Database, which provided claims data belonging to kidney transplant recipients during 1997-2006. Multivariate analysis was used to identify independent risk factors for TB after kidney transplantation. Kaplan-Meier survival analysis was used to assess the outcome of patients with TB.
  
  
  RESULTS
  Among 4554 kidney transplant recipients over the 10-year period, 109 (2.4%) patients with newly diagnosed TB were identified: 75 patients with only pulmonary involvement, and 34 with extrapulmonary spread. The incidence of kidney transplant recipients developing TB was 638 per 100,000 person-years. The independent risk factors for post-transplant TB included cyclosporine-based immunosuppressant agents during the first year after kidney transplantation (odds ratio [OR]: 1.98, P = 0.001), hepatitis C infection (OR: 1.79, P = 0.024), and chronic obstructive pulmonary disease (OR: 1.50, P = 0.041). Kidney transplant recipients who developed TB had a lower 5-year survival rate than those who did not (78.6% vs. 93.4%, P = 0.001).
  
  
  CONCLUSIONS
  Kidney transplant recipients in Taiwan did have a high risk of TB infection, with high proportion of extrapulmonary spread. Physicians need to be vigilant in surveying for TB in kidney transplantation, especially in high-risk patients.
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: S-M
authors.initials: SM
authors.lastname: Ou
authors.forename: C-J
authors.initials: CJ
authors.lastname: Liu
authors.forename: C-J
authors.initials: CJ
authors.lastname: Teng
authors.forename: Y-T
authors.initials: YT
authors.lastname: Lin
authors.forename: Y-S
authors.initials: YS
authors.lastname: Chang
authors.forename: S-C
authors.initials: SC
authors.lastname: Chiang
authors.forename: C-H
authors.initials: CH
authors.lastname: Tzeng
authors.forename: T-J
authors.initials: TJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality*
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine