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Kidney Week

Abstract: PO2462

Risk of Active Tuberculosis Infection in Kidney Transplantation Recipients: A Matched Comparative Nationwide Cohort Study

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Park, Sehoon, Armed Forces Capital Hospital, Seongnam, Gyeonggi-do, Korea (the Republic of)
  • Kim, Ji Eun, Korea University Guro Hospital, Seoul, Korea (the Republic of)
  • Yu, Mi-yeon, Hanyang University Guri Hospital, Gyeonggi-do, Gyeonggi-do, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Joo, Kwon Wook, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Han, Kyungdo, Soongsil University, Dongjak-gu, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
Background

Although the risk of mycobacterium tuberculosis (TB) infection is high in both kidney transplantation (KT) recipients and dialysis patients, a large-scale evidence comparing the risk between the two groups in a nation with moderate or higher TB prevalence was rare.

Methods

We performed a nationwide retrospective cohort study based on the claims database of South Korea where moderate TB prevalence is reported. We included incident KT recipients from 2011 to 2015 and compared their active-TB risks with matched controls. The 1:1 matched general population group was matched for age, sex, and era, while the dialysis group was matched for age, sex, era, underlying hypertension, and diabetes. We excluded the matched pairs with age < 20 years old, a previous TB history, and those matched to a multi-organ transplantation case. The incident active-TB risk was assessed by the multivariable Cox regression analysis. Within KT group, associations between active-TB, as a time-dependent variable, and post-transplant death or death-censored graft failure was investigated.

Results

The number of matched 7,462 subjects (total 22,386) were included to each of the study groups. During median 3.57 years of follow-up duration, the incidence rate for active-TB was 3.92/1,000, 4.38/1,000, and 0.67/1,000 person-years in the KT, dialysis, and general population groups, respectively. The KT group showed a significantly higher risk of active-TB than the general population group [adjusted HR 3.39 (1.88-6.12)] but a similar to the dialysis group [adjusted HR 0.98 (0.73-1.31)]. Active-TB was a significant risk factor for death [adjusted HR 2.24 (1.19-4.42)] or death-censored graft failure [adjusted HR 2.21 (1.36-3.58)] in the KT patients.

Conclusion

In Korea with moderate TB prevalence and active surveillance strategies, KT patients may not have to burden additional risk of active-TB when compared to dialysis patients. Still, clinical attention for active-TB complication should not be overlooked in end-stage kidney disease patients, particularly for KT patients as active-TB was associated with worse post-transplant prognosis.