Journal Article

Tuberculosis after Solid-Organ Transplant: Incidence, Risk Factors, and Clinical Characteristics in the RESITRA (Spanish Network of Infection in Transplantation) Cohort

Julián Torre-Cisneros, Antonio Doblas, José María Aguado, Rafael San Juan, Marino Blanes, Miguel Montejo, Carlos Cervera, Oscar Len, Jordi Carratala, José Miguel Cisneros, Germán Bou, Patricia Muñoz, Antonio Ramos, Merce Gurgui, Nuria Borrell, Jesus Fortún, Asunción Moreno and Joan Gavalda

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 48, issue 12, pages 1657-1665
Published in print June 2009 | ISSN: 1058-4838
Published online June 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/599035
Tuberculosis after Solid-Organ Transplant: Incidence, Risk Factors, and Clinical Characteristics in the RESITRA (Spanish Network of Infection in Transplantation) Cohort

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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 105 patients per year (95% confidence interval [CI], 317–783), which was higher than that in the general population in Spain (18.9 cases per 105 inhabitants per year; relative risk [RR], 26.6). The highest incidence (2072 cases per 105 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.

Journal Article.  4147 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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