Department of Internal Medicine, Division of Infectious Disease, Yonsei University College of Medicine, Yonsei University, Seoul, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Transpl Infect Dis. 2021 Dec;23(6):e13729. doi: 10.1111/tid.13729. Epub 2021 Dec 15.
The management of active tuberculosis (TB) in solid organ transplantation (SOT) recipients is challenging given the pharmacological interaction and the potential delays in diagnosis due to atypical presentation. The incidence rates (IRs) of post-SOT TB from the whole recipients' cohort in a high-endemic country have not been evaluated.
We established a SOT cohort (n = 15 598) and confirmed cases of TB between 2011 and 2015 from the Korean National Health Insurance Database using ICD-10 codes. After excluding 1302 and 180 SOT-recipients due to age (<18 years) and presence of pre-SOT TB and/or treatment for latent TB during wash-out period between 2006 and cohort entry, we analyzed 14 116 SOT recipients and 70 580 individuals with no history of SOT matched by age and sex. The hazard ratios (HRs) of IRs were adjusted for age, sex, low-income status, diabetes mellitus, chronic co-morbidities, and anti-TNF-α therapy.
The IR of TB was significantly higher (adjusted HR [aHR]: 6.1, 95% confidence interval [CI]: 4.5-7.6) in SOT recipients (4.9/1000 person-years) than in non-SOT individuals (0.8/1000 person-years). Of the transplanted organs, the pancreas (pancreas alone and simultaneous pancreas-kidney) and lung had the highest IR (aHR: 16.3 [6.1-42.2] and 16.1 [5.9-43.8], respectively). The use of anti-thymocyte globulin and azathioprine was associated with a higher IR (aHR: 1.53 [1.01-2.43] and 3.92 [1.21-12.47], respectively), but basiliximab was associated with a lower IR (aHR: 0.67 [0.48-0.98]).
The IR of TB in SOT recipients, especially in the pancreas and lung, was significantly higher than that in the non-SOT population.
由于药物相互作用以及非典型表现导致诊断延迟，实体器官移植（SOT）受者中活动性结核病（TB）的管理颇具挑战性。在高流行国家，尚未评估整个受者队列中 SOT 后 TB 的发病率（IR）。
我们建立了一个 SOT 队列（n = 15598），并使用 ICD-10 代码从韩国国家健康保险数据库中确认了 2011 年至 2015 年间的 TB 病例。排除年龄（<18 岁）、SOT 前 TB 和/或 2006 年洗脱期至队列入组期间存在潜伏性 TB 且接受治疗的 1302 例和 180 例 SOT 受者后，我们分析了 14116 例 SOT 受者和 70580 例年龄和性别匹配、无 SOT 史的个体。IR 的风险比（HR）经年龄、性别、低收入状况、糖尿病、慢性合并症和抗 TNF-α 治疗调整。
SOT 受者（4.9/1000人年）的 TB 发病率明显高于非 SOT 个体（0.8/1000 人年）（调整后的 HR [aHR]：6.1，95%置信区间[CI]：4.5-7.6）。在移植器官中，胰腺（单纯胰腺和胰腺-肾脏同时移植）和肺的 IR 最高（aHR：16.3[6.1-42.2]和 16.1[5.9-43.8]）。使用抗胸腺细胞球蛋白和硫唑嘌呤与更高的 IR 相关（aHR：1.53[1.01-2.43]和 3.92[1.21-12.47]），但巴利昔单抗与更低的 IR 相关（aHR：0.67[0.48-0.98]）。
SOT 受者，尤其是胰腺和肺，的 TB IR 明显高于非 SOT 人群。
