title: A nationwide population-based study of the risk of tuberculosis in different solid organ transplantations in Taiwan.
abstract: Advances in immunosuppressants for solid organ transplantation (SOT) have improved prevention and treatment of acute rejection as well as reduced the risk of chronic graft damage. However, SOT recipients are prone to developing opportunistic infections because of their long-term immunosuppressed status. Tuberculosis (TB) is a serious opportunistic infection that is associated with increased morbidity and mortality in SOT recipients. However, nationwide population-based research specifically focused on the associations between kidney transplantation (KTx), liver transplantation (LTx), and heart transplantation (HTx), and subsequent TB infection is lacking. This study was conducted using Taiwan's National Health Insurance Research Database, which provided claims data for SOT recipients from 2000 to 2009. Clinical features, treatment, and outcomes were analyzed to determine the risk for TB after SOT. In total, 153 (3.2%) RTx, 19 (1.1%) LTx, and 26 (2.8%) HTx recipients became infected with TB. Compared with non-TB patients, HTx recipients with TB had significantly higher prevalence of older age (P = .037), hypertension (P < .001), and coronary artery disease (CAD) (P = .002). There were also greater percentages of male sex (P = .018), diabetes (P = .029), hyperlipidemia (P = .016), CAD (P < .001), and chronic obstructive pulmonary disease (COPD) (P < .001) in RTx recipients with TB than in those without. In conclusion, posttransplantation TB is a serious problem worldwide, and a high index of suspicion is warranted to ensure early diagnosis and prompt initiation of treatment for TB among SOT patients. In this preliminary study, KTx recipients had a higher risk of TB infection than LTx and HTx recipients, and the high-risk factors were male sex, diabetes, hyperlipidemia, CAD, and COPD. The use of optimal immunosuppressive agents to minimize acute rejection, monitoring of high-risk recipients, prompt diagnosis, and appropriate treatment are required for the management of TB infection in endemic areas such as Taiwan.
authors.affiliation: Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: K-H
authors.initials: KH
authors.lastname: Shu
authors.affiliation: Division of Urology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: H-C
authors.initials: HC
authors.lastname: Ho
authors.affiliation: Liver Transplantation Center, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: S-B
authors.initials: SB
authors.lastname: Cheng
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Liver Transplantation Center, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Wei
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: S-N
authors.initials: SN
authors.lastname: Chang
authors.affiliation: School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan. Electronic address: wmj530708@yahoo.com.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology / Q000401:mortality; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology / Q000401:mortality
chemical_list: D007166:Immunosuppressive Agents