RISK OF TUBERCULOSIS IN KIDNEY TRANSPLANTATION RECIPIENTS COMPARED TO DIALYSIS PATIENTS OR GENERAL POPULATION: A NATIONWIDE COHORT STUDY WITH MATCHED CONTROLS

Abstract

Background: Risk of Mycobacterium tuberculosis (TB) infection has been reported to be increased in kidney transplant recipients. However, a nationwide cohort study from an Asian country with moderate incidence of TB is rare, although prevalence of CKD is increasing in TB endemic regions. In addition, a study comparing the risk of TB in kidney transplantation both to healthy population and dialysis patients was warranted. Methods: We performed a nationwide, population-based cohort study using the national claims database of Korea in which nationwide health insurance is provided. We included kidney transplantation recipients from 2009 to 2015. Two control groups, end-stage renal disease (ESRD) group and healthy population, were collected from matching with age, sex, and era. When constructing the matched ESRD group, histories of diabetes and hypertension were additionally matched. Those who had a history of TB were excluded. The risk of TB was assessed with the Cox regression analysis. Results: We included 11,302 subjects in the transplantation group, and the same numbers in the ESRD and healthy control groups, respectively. The study population had most commonly age from 40 to 49, and 59.3 % were male. Among those who are receiving renal replacement therapy, 41.9 % had diabetes and 91.7% hypertension. Number of identified incident active-TB cases were 161, 154, and 46 cases in the kidney transplantation, ESRD, and healthy groups, respectively. The risk of TB was significantly increased in the kidney transplantation [adjusted HR 2.32 (1.43-3.75)] and the ESRD [adjusted HR 2.16 (1.34-3.48) groups, but between the two groups with history of kidney replacement therapy, no significant difference was identified [adjusted HR 0.93 (0.75-1.17)]. Old age, male sex and diabetes were the significant risk factors for TB in the kidney transplantation group. Conclusion: Risk of TB is increased in the patients receiving renal replacement therapy in Korea, when compared to the healthy controls. Kidney transplant recipients showed similar TB risks as dialysis patients.