Incidence and Risk Factors for Tuberculosis After Liver Transplantation in an Endemic Area: A Nationwide Population-Based Matched Cohort Study

Abstract

These authors contributed equally to this work.Morbidity and mortality from tuberculosis (TB) are high in Taiwan. We conducted a nationwide populationbased matched cohort study using data retrieved from the Taiwan's National Health Insurance Research Database to determine the impact of TB after liver transplantation (LT). During 2000-2011, we identified 3202 liver transplant recipients and selected subjects from the general population matched for age, sex, and comorbidities on the same index date of recognition of LT with a 1:10 ratio. The data were analyzed using Cox proportional hazards models. Compared to the matched cohort, liver transplant patients had a higher risk for TB (adjusted HR 2.25, 95% CI 1.65-3.05, p < 0.001), and those with TB showed higher mortality (HR 2.27, 95% CI 1.30-3.97, p ¼ 0.004). Old age (HR 2.64, 95% CI 1.25-5.54, p ¼ 0.011) and mammalian target of rapamycin inhibitors (mTORis) (HR 3.09, 95% CI 1.68-5.69, p < 0.001) were significant risk factors for TB in LT; mTORis were also associated with mortality after adjusting for confounders (HR 2.13, 95% CI 1.73-2.62, p < 0.001). Therefore, regular surveillance of TB and treatment of latent TB infection in high-risk patients after LT are important, especially in TB-endemic areas.

Mycobacterium tuberculosisafter solid organ transplantation: A review of more than 2000 cases

“…A total of 253 TB cases among liver recipients were reported in 20 cohort studies and 22 case reports . Of these, 78 of 106 cases (73.58%) were male.…”

“…A total of 253 TB cases among liver recipients were reported in 20 cohort studies 141,142,144,146,147,149,151,153,157,161,163,169,171,172,175,177,184,185,187,189 and 22 case reports. 8,10,15,18,22,27,31,32,39,45,47-49, 72,76,77,93,104,114,115,124,137 Of these, 78 of 106 cases (73.58%) were male.…”

Risk of tuberculosis after lung transplantation: the value of pretransplant chest computed tomography and the impact of mTOR inhibitors and azathioprine use

“…Specifically, we found an article in which a kidney transplant recipient undergoing treatment with everolimus suffered from TB . In addition to that study, an association was found between the use of mTOR inhibitors (sirolimus and everolimus) and the development of TB after transplantation in a cohort of liver transplant recipients in Taiwan . As regards the pathophysiological mechanism that could favor the development of TB because of everolimus therapy, it is known that everolimus inhibits cellular immunity and possibly stimulates the production of interleukin‐10, which may facilitate the reactivation of latent infections.…”

Mycobacterium tuberculosis DNA in living donor transplanted livers and donor‐related tuberculosis in recipients: A retrospective longitudinal cohort study

“…The cumulative risk of tuberculosis in liver transplantation is estimated to be 0.8 percent in developed countries and 2 percent in developing countries . The disease is associated with significant morbidity and mortality in developed and developing countries . The risk varies depending on transplanted organ and tuberculosis epidemiology in the donor/recipient population.…”