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Risk of Solid Organ Transplantation in Individuals With Celiac Disease: A Nationwide Cohort Study
John B Doyle1, Benjamin Lebwohl1, Jonas Soderling2
1Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Medicine, Celiac Disease Center, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York.
Insights
Individuals with celiac disease (CeD) face a nearly threefold higher risk of requiring solid organ transplantation. This increased risk is particularly pronounced for liver transplantation, highlighting a significant association between CeD and severe organ disease.
Area of Science:
- Gastroenterology and Hepatology
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Celiac disease (CeD) is linked to chronic liver, kidney, and heart conditions.
- The specific risk of severe organ disease necessitating transplantation in CeD patients remains unclear.
Purpose of the Study:
- To quantify the risk of solid organ transplantation in individuals diagnosed with celiac disease.
- To compare transplantation rates in CeD patients against the general population.
Main Methods:
- A population-based matched cohort study was conducted in Sweden.
- Individuals with biopsy-proven CeD (2000-2023) were identified via the ESPRESSO histopathology cohort.
- Cox proportional hazards models were used to estimate the relative risk of solid organ transplantation (liver, heart, kidney, lung).
Main Results:
- The study included 41,277 CeD patients and 196,863 matched controls.
- CeD patients had a significantly higher incidence of solid organ transplantation (17.0 vs. 4.6 per 100,000 person-years).
- An adjusted hazard ratio of 2.76 indicated a 2.76-fold increased risk of transplantation in CeD individuals, with significant risks for liver (HR 7.26) and kidney (HR 1.85) transplants.
Conclusions:
- Celiac disease is associated with a substantially increased risk of requiring solid organ transplantation.
- The risk is particularly elevated for liver transplantation, suggesting a strong link between CeD and end-stage liver disease.
- Further investigation into the underlying pathophysiology connecting CeD and severe organ damage is warranted.
Background & Aims:
Celiac disease (CeD) is associated with chronic diseases of the liver, kidney, and heart. Despite this, the risk of severe disease requiring transplantation has not been established. Our objective was to measure the risk of solid organ transplantation in individuals with celiac disease relative to that of the general population.
Methods:
This was a population-based matched cohort study in Sweden. We identified individuals with biopsy-proven celiac disease diagnosed between 2000 and 2023 using the nationwide histopathology cohort, ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden). We calculated the incidence of solid organ transplantation (liver, heart, kidney, and lung) in patients with celiac disease and estimated the risk relative to the general population using Cox proportional hazards models. In secondary analyses, we estimated the risk of liver, heart, and kidney transplants specifically.
Results:
We identified 41,277 individuals with celiac disease and 196,863 age- and sex-matched comparators. During a mean follow-up of 12.1 years, there were 85 solid organ transplantations in patients with celiac disease (17.0 per 100,000 person-years) and 111 in matched comparators (4.6 per 100,000 person-years). This corresponded to an adjusted hazard ratio of 2.76 (95% confidence interval, 1.96-3.89). There was a significantly increased risk of liver transplantation (hazard ratio, 7.26; 95% confidence interval, 3.88-13.56) and kidney transplantation (hazard ratio, 1.85; 95% confidence interval, 1.11-3.10), but the hazard ratio for heart transplantation did not attain statistical significance (hazard ratio, 2.35; 95% confidence interval, 0.84-6.61).
Conclusions:
In this nationwide study, celiac disease was associated with an almost 3-fold increased risk of solid organ transplantation, particularly liver transplantation. Further research is needed to explore the pathophysiological relationship between celiac disease and end-stage organ disease.
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