PDF(Pubmed)
Abstract：
BACKGROUND: Transplant recipients are immunocompromised and vulnerable to developing tuberculosis. However, active tuberculosis incidence is rapidly declining in South Korea, but the trend of tuberculosis infection among transplant recipients has not been elucidated. This study aimed to evaluate the risk of active tuberculosis after transplantation, including risk factors for tuberculosis and standardized incidence ratios, compared with that in the general population.
METHODS: This retrospective study was conducted based on the South Korean health insurance review and assessment database among those who underwent transplantation (62,484 recipients) between 2008 and 2020. Tuberculosis incidence was compared in recipients treated during higher- (2010-2012) and lower-disease burden (2016-2018) periods. Standardized incidence ratios were analyzed using the Korean Tuberculosis Surveillance System. The primary outcome was the number of new tuberculosis cases after transplantation.
RESULTS: Of 57,103 recipients analyzed, the overall cumulative incidence rate 1 year after transplantation was 0.8% (95% confidence interval [CI]: 0.7-0.8), significantly higher in the higher-burden period than in the lower-burden period (1.7% vs. 1.0% 3 years after transplantation, P < 0.001). Individuals who underwent allogeneic hematopoietic stem cell transplantation had the highest tuberculosis incidence, followed by those who underwent solid organ transplantation and autologous hematopoietic stem cell transplantation (P < 0.001). The overall standardized incidence ratio was 3.9 (95% CI 3.7-4.2) and was the highest in children aged 0-19 years, at 9.0 (95% CI 5.7-13.5). Male sex, older age, tuberculosis history, liver transplantation, and allogeneic hematopoietic stem cell transplantation were risk factors for tuberculosis.
CONCLUSIONS: Transplant recipients are vulnerable to developing tuberculosis, possibly influenced by their immunocompromised status, solid organ transplant type, age, and community prevalence of tuberculosis. Tuberculosis prevalence by country, transplant type, and age should be considered to establish an appropriate tuberculosis prevention strategy for high-risk groups.
METHODS: This retrospective study was conducted based on the South Korean health insurance review and assessment database among those who underwent transplantation (62,484 recipients) between 2008 and 2020. Tuberculosis incidence was compared in recipients treated during higher- (2010-2012) and lower-disease burden (2016-2018) periods. Standardized incidence ratios were analyzed using the Korean Tuberculosis Surveillance System. The primary outcome was the number of new tuberculosis cases after transplantation.
RESULTS: Of 57,103 recipients analyzed, the overall cumulative incidence rate 1 year after transplantation was 0.8% (95% confidence interval [CI]: 0.7-0.8), significantly higher in the higher-burden period than in the lower-burden period (1.7% vs. 1.0% 3 years after transplantation, P < 0.001). Individuals who underwent allogeneic hematopoietic stem cell transplantation had the highest tuberculosis incidence, followed by those who underwent solid organ transplantation and autologous hematopoietic stem cell transplantation (P < 0.001). The overall standardized incidence ratio was 3.9 (95% CI 3.7-4.2) and was the highest in children aged 0-19 years, at 9.0 (95% CI 5.7-13.5). Male sex, older age, tuberculosis history, liver transplantation, and allogeneic hematopoietic stem cell transplantation were risk factors for tuberculosis.
CONCLUSIONS: Transplant recipients are vulnerable to developing tuberculosis, possibly influenced by their immunocompromised status, solid organ transplant type, age, and community prevalence of tuberculosis. Tuberculosis prevalence by country, transplant type, and age should be considered to establish an appropriate tuberculosis prevention strategy for high-risk groups.
摘要：
背景：移植受者免疫受损，易发生结核病。然而,韩国的活动性结核病发病率正在迅速下降，但是移植受者中结核病感染的趋势尚未阐明。本研究旨在评估移植后活动性结核病的风险。包括结核病的危险因素和标准化发病率，与普通人群相比。
方法：这项回顾性研究是根据韩国健康保险审查和评估数据库在2008年至2020年间接受移植的患者（62,484名受者）中进行的。比较了在较高（2010-2012年）和较低疾病负担（2016-2018年）期间接受治疗的接受者的结核病发病率。使用韩国结核病监测系统分析了标准化的发病率。主要结果是移植后新结核病例的数量。
结果：分析了57103名收件人，移植后1年的总累积发病率为0.8%(95%置信区间[CI]:0.7-0.8),高负担期明显高于低负担期(1.7%与移植3年后1.0%,P<0.001)。接受异基因造血干细胞移植的个体结核病发病率最高，其次是接受实体器官移植和自体造血干细胞移植的患者（P<0.001）。总体标准化发生率为3.9（95％CI3.7-4.2），在0-19岁儿童中最高，9.0（95%CI5.7-13.5）。男性,年龄较大,结核病史,肝移植,异基因造血干细胞移植是结核病的危险因素。
结论：移植受者容易患结核病，可能受到免疫功能低下状态的影响，实体器官移植类型,年龄,和社区结核病患病率。按国家分列的结核病患病率，移植类型,应考虑年龄，为高危人群制定适当的结核病预防策略。
方法：这项回顾性研究是根据韩国健康保险审查和评估数据库在2008年至2020年间接受移植的患者（62,484名受者）中进行的。比较了在较高（2010-2012年）和较低疾病负担（2016-2018年）期间接受治疗的接受者的结核病发病率。使用韩国结核病监测系统分析了标准化的发病率。主要结果是移植后新结核病例的数量。
结果：分析了57103名收件人，移植后1年的总累积发病率为0.8%(95%置信区间[CI]:0.7-0.8),高负担期明显高于低负担期(1.7%与移植3年后1.0%,P<0.001)。接受异基因造血干细胞移植的个体结核病发病率最高，其次是接受实体器官移植和自体造血干细胞移植的患者（P<0.001）。总体标准化发生率为3.9（95％CI3.7-4.2），在0-19岁儿童中最高，9.0（95%CI5.7-13.5）。男性,年龄较大,结核病史,肝移植,异基因造血干细胞移植是结核病的危险因素。
结论：移植受者容易患结核病，可能受到免疫功能低下状态的影响，实体器官移植类型,年龄,和社区结核病患病率。按国家分列的结核病患病率，移植类型,应考虑年龄，为高危人群制定适当的结核病预防策略。
