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Changes in tuberculosis risk after transplantation in the setting of decreased community tuberculosis incidence: a national population-based study, 2008-2020

Authors
 JongHoon Hyun  ;  Myeongjee Lee  ;  Inkyung Jung  ;  Eunhwa Kim  ;  Seung Min Hahn  ;  Yu Ri Kim  ;  Sungmin Lim  ;  Kyong Ihn  ;  Min Young Kim  ;  Jong Gyun Ahn  ;  Joon-Sup Yeom  ;  Su Jin Jeong  ;  Ji-Man Kang 
Citation
 ANNALS OF CLINICAL MICROBIOLOGY AND ANTIMICROBIALS, Vol.23(1) : 1, 2024-01 
Journal Title
ANNALS OF CLINICAL MICROBIOLOGY AND ANTIMICROBIALS
Issue Date
2024-01
MeSH
Child ; Hematopoietic Stem Cell Transplantation* / adverse effects ; Humans ; Incidence ; Male ; Organ Transplantation* / adverse effects ; Retrospective Studies ; Risk Factors ; Tuberculosis* / epidemiology
Keywords
Community tuberculosis burden ; Hematopoietic stem cell transplantation ; Solid organ transplantation ; Standardized incidence ratio ; Tuberculosis
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. Graphical Abstract: [Figure not available: see fulltext.] © 2023, The Author(s).
Files in This Item:
T202400630.pdf Download
DOI
10.1186/s12941-023-00661-4
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Ji-Man(강지만) ORCID logo https://orcid.org/0000-0002-0678-4964
Kim, Yu Ri(김유리) ORCID logo https://orcid.org/0000-0001-5505-0142
Ahn, Jong Gyun(안종균) ORCID logo https://orcid.org/0000-0001-5748-0015
Yeom, Joon Sup(염준섭) ORCID logo https://orcid.org/0000-0001-8940-7170
Lee, Myeongjee(이명지)
Ihn, Kyong(인경) ORCID logo https://orcid.org/0000-0002-6161-0078
Lim, Sungmin(임성민)
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Jung, Inkyung(정인경) ORCID logo https://orcid.org/0000-0003-3780-3213
Hahn, Seung Min(한승민) ORCID logo https://orcid.org/0000-0001-9832-6380
Hyun, Jong Hoon(현종훈) ORCID logo https://orcid.org/0000-0002-9621-0250
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198560
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