Posttransplant tuberculosis in Europe – a TBnet study

<b>Background:</b> Evidence on tuberculosis (TB) incidence and management of risk of TB after solid organ transplant (SOT) in Europe is scarce. <b>Methods:</b> The effect of screening for latent infection with Mycobacterium tuberculosis (LTBI) with TST/IGRA on TB incidence rates (IR) after SOT is assessed in successive SOT patients from 2007 to 2012 in transplant centres (TC) in Europe in a multivariate survival analysis, accounting for competing risk of death and clustering by TC. Regional differences of TB IR are assessed in a fixed effects meta-analysis on standardized incidence ratios (SIR) of TB after SOT. <b>Results:</b> Of 6534 patients (72% kidney, 17% liver, 11% heart/lung) in 15 TCs from 8 countries, 37 developed TB during 33261 person years (pys). 31% were screened for LTBI and 110/236 (46%) those with LTBI were offered chemoprevention (CP). TB IR after SOT was 111/100.000 pys (95%CI 81-154), highest in the first two years after SOT (321/100.000 pys). There was no evidence of reduced TB IR after screening (HR 0.6, 95%CI 0.3-1.4) adjusting for sex, age, immigration, ethnicity, country/type of SOT, previous TB, diabetes and smoking. However, if screened positive but not offered CP patients had higher TB IR than if not screened (HR 2.9, 95%CI 1.6-5.3). The meta-analysis yielded high SIRs in southern Europe (Spain/Portugal, pooled SIR 14, 95%CI 6.5-21.8) compared to central Europe (Austria, Czech Republic, Germany, Netherlands, Serbia, UK, pooled SIR 3.7, 95%CI 0.5-6.9), with the highest crude TB IR in a liver-TC in Portugal (729/100.000 pys, 95%CI 414-1284). <b>Discussion:</b> Posttransplant TB IRs are highly variable in Europe. While TB after SOT is rare in central Europe, LTBI testing and CP should be intensified for SOT recipients in southern Europe.