Mycobacterium Tuberculosis Infection Incidence in Hospitalized Renal Transplant Patients in the United States, 1998–2000

Authors

  • Mary M. Klote,

    1. Department of Medicine, Walter Reed Army Medical Center (WRAMC), Washington, D.C., USA
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  • Lawrence Y. Agodoa,

    1. National Institute of Digestive, Diabetes, and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
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  • Kevin Abbott

    Corresponding author
    1. Nephrology Service, Walter Reed Army Medical Center (WRAMC), Washington, D.C., and Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
      *Corresponding author: Kevin Abbott, kevin.abbott@na.amedd.army.mil
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  • The opinions are solely those of the authors and do not represent an endorsement by the Department of Defense or the National Institutes of Health. This is a US Government work. There are no restrictions on its use.

*Corresponding author: Kevin Abbott, kevin.abbott@na.amedd.army.mil

Abstract

The incidence, risk factors, and prognosis for Mycobacterium tuberculosis (MTB) infection have not been reported in a national population of renal transplant recipients. We performed a retrospective cohort study of 15 870 Medicare patients who received renal transplants from January 1 1998 to July 31 2000. Cox regression analysis derived adjusted hazard ratios (AHR) for factors associated with a diagnosis of MTB infection (by Medicare Institutional Claims) and the association of MTB infection with survival. There were 66 renal transplant recipients diagnosed with tuberculosis infection after transplant (2.5 cases per 1000 person years at risk, with some falling off of cases over time). The most common diagnosis was pulmonary TB (41 cases). In Cox regression analysis, only systemic lupus erythematosus (SLE) was independently associated with TB. Mortality after TB was diagnosed was 23% at 1 year, which was significantly higher than in renal transplant recipients without TB (AHR, 4.13, 95% CI, 2.21, 7.71, p < 0.001). Although uncommon, MTB infection is associated with a substantially increased risk of mortality after renal transplantation. High-risk groups, particularly those with SLE prior to transplant, might benefit from intensified screening.

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