Incidence, Risk Factors, and Mortality Associated with Tuberculosis in Solid Organ Transplant Recipients in Taiwan

Solid organ transplantation (SOT) recipients are at increased risk of post-transplant tuberculosis (TB). However, the effect of this risk on mortality remains unclear. We examined the incidence and risk factors of posttransplant TB, and its effect on mortality in SOT recipients in Taiwan.

We collected data on 8,205 patients who received their first transplants from 2009 to 2018 from the National Health Insurance Research Database, and identified 201 new TB cases. Transplants were identified and verified by the medical procedure codes. A Cox proportional-hazards model was used to identify the determinants of TB infection.

For the 7,685 recipients, with 34,412 person-years (PYs), 1,630 deaths (393.41/1,000 PYs) were reported. Male sex was associated with a 44 % increase in the risk of TB (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.05 to 1.98). In addition, age over 65 years was associated with a 4-fold increase in the risk of TB (HR, 4.04; 95% CI, 2.04 to 8.00). The mortality rates in the population varied by transplantation organ type (lungs, 187.75/1,000 PYs; heart, 81.11/1,000 PYs; liver:, 58.47/1,000 PYs; pancreas, 42.36/1,000 PYs; and kidneys, 23.76/1,000 PYs). Recipients with posttransplant TB had a 2.53-fold increased risk of mortality (HR, 2.53; 95% CI, 1.94 to 3.29).

Posttransplant TB is associated with an increased risk of mortality in SOT recipients. Preventing TB can mitigate this risk, which underscores the importance of monitoring and managing TB in this population.