Clinical characteristics, risk factors, and treatment outcomes of tuberculosis in recipients of solid organ or hematopoietic stem cell transplantation

Background Tuberculosis (TB) is one of the most severe complications following organ and tissue transplantation. Early detection and prompt initiation of anti-TB therapy are therefore essential to reduce mortality among transplant recipients. Methods A retrospective cohort analysis was conducted involving 42 transplant recipients who developed new-onset or recurrent TB following solid organ transplantation (SOT) or hematopoietic stem cell transplantation (HSCT) between January 1, 2017, and February 28, 2025. The objective of this study was to investigate the clinical characteristics and prognosis of TB, as well as risk factors associated with severe TB among SOT and HSCT recipients. Results Among the 42 transplant recipients included in this study, the median time from SOT or HSCT to the onset of new or recurrent TB was 24 months (interquartile range [IQR]: 0.5-180 months). The median time from the symptom onset to TB diagnosis was 26 days (IQR: 1-180 days). The clinical types of TB comprised secondary pulmonary TB (36 cases, 85.71 %), disseminated TB (14 cases, 33.33 %), hematogenous disseminated pulmonary TB (7 cases, 16.67 %), and extrapulmonary TB (19 cases, 45.24 %). Co-infections were detected in 17 TB patients (40.48 %). Severe TB accounted for 28.58 % of all cases. Hypoproteinemia (OR = 0.532, 95 % CI 0.302-0.937; P = 0.029), co-infections (OR = 44.00, 95 % CI 4.712-410.855; P = 0.001), and early post-transplant onset of TB (OR = 0.963, 95 % CI 0.930-0.988; P = 0.036) were identified as independent risk factors for severe TB. The overall treatment success rate for TB was 57.14 %. The 6-month and 12-month overall survival rates were 85.7 % and 78.6 %, respectively. Conclusion Our findings indicate that TB may occur at any time following SOT or HSCT, and often affects extrapulmonary sites. Severe TB is relatively common and frequently associated with co-infections, which contribute to increased mortality. Clinically, these results underscore the importance of regular TB screening of transplant recipients.