Tuberculosis incidence in solid organ transplant recipients in Europe: A multicenter TBnet cohort study

Berit Lange; Thomas Theo Brehm; Sandra M. Arend; Miguel Arias-Guillén; Marleen Bakker; Cristina Berastegui; Maaz Babiker; Rawya Charif; Raquel Duarte; Holger Flick; Regina W. Hofland; Joanna Ismail; Daniela Kniepeiss; Jessica Krepel; Nithya Krishnan; Dora L. Kuijpers; Heinke Kunst; Frank van Leth; Visnja Lezaic; Ibai Los-Arcos; Jana Machová; Heather Milburn; Sandra A. Morais; Onn Min Kon; Carmen Osoro-Suarez; Helena Pessegueiro Miranda; Dragica Pesut; Ananna Rahman; Tomas Reischig; Adrián Sánchez-Montalvá; Hanna Elisa Spohn; Merel T. Stegenga; Aiko P. J. de Vries; Dirk Wagner; Rika Wobser; Christoph Lange; Martina Sester

doi:10.1016/j.jinf.2025.106668

Tuberculosis incidence in solid organ transplant recipients in Europe: A multicenter TBnet cohort study

Berit Lange
, Thomas Theo Brehm
, Sandra M. Arend
, Miguel Arias-Guillén
, Marleen Bakker
, Cristina Berastegui
, Maaz Babiker
, Rawya Charif
, Raquel Duarte
, Holger Flick
, Regina W. Hofland
, Joanna Ismail
, Daniela Kniepeiss
, Jessica Krepel
, Nithya Krishnan
, Dora L. Kuijpers
, Heinke Kunst
, Frank van Leth
, Visnja Lezaic
, Ibai Los-Arcos

Jana Machová, Heather Milburn, Sandra A. Morais, Onn Min Kon, Carmen Osoro-Suarez, Helena Pessegueiro Miranda, Dragica Pesut, Ananna Rahman, Tomas Reischig, Adrián Sánchez-Montalvá, Hanna Elisa Spohn, Merel T. Stegenga, Aiko P. J. de Vries, Dirk Wagner, Rika Wobser, Christoph Lange, Martina Sester

Helmholtz Centre for Infection Research
Research Center Borstel - Leibniz Lung Center
Leiden University
Hospital Universitario Central de Asturias
Erasmus University Rotterdam
Hospital Vall d’Hebron
University Hospitals Coventry and Warwickshire NHS Trust
Imperial College Healthcare NHS Trust
National Institute of Health Dr. Ricardo Jorge
Medical University of Graz
Utrecht University
St Mary's Hospital
Queen Mary University of London
Vrije Universiteit Amsterdam
University of Belgrade
Charles University and Teaching Hospital
Guy's and St Thomas' NHS Foundation Trust
University Hospital Center of Santo António
University of Porto
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas
Saarland University
University of Freiburg

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Solid organ transplant (SOT) recipients face elevated tuberculosis risk, yet optimal prevention strategies in low- to medium-incidence regions remain unclear. METHODS: We conducted a multicenter retrospective cohort study of adult SOT recipients transplanted between 2007 and 2012 at 15 European centers, with follow-up through 2018. The primary outcome was microbiologically confirmed post-transplant tuberculosis. Incidence rates were calculated per 100,000 person-years; standardized incidence ratios (SIRs) used World Health Organization country-specific background rates. Cox models assessed risk factors. RESULTS: Among 5805 patients (median age 51; 62.7% male; 73.9% renal transplants), 33.8% were tested for tuberculosis infection and 10.3% received tuberculosis preventive therapy (TPT). Over 33,785 person-years, 23 patients (0.4%) developed tuberculosis (68.0/100,000 person-years). Highest incidence occurred in patients with positive screening but no TPT (233.8/100,000). Incidence was higher in Southern vs. Central Europe (251.9 vs. 28.7/100,000), with pooled SIRs of 12.8 and 3.1, respectively. Tuberculosis risk was elevated among Southern European recipients (HR 22.9) and those with migration history (HR 2.7). CONCLUSION: Tuberculosis risk is increased in European SOT recipients. Regionally adapted prevention strategies, including targeted screening in low-incidence areas and universal screening in higher-incidence regions, are warranted.

Original language	English
Article number	106668
Pages (from-to)	106668
Journal	Journal of infection
Volume	92
Issue number	1
DOIs	https://doi.org/10.1016/j.jinf.2025.106668
Publication status	Published - 1 Jan 2026
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

IGRA
Progression to tuberculosis
TBnet
Transplantation
Tuberculosis

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Tuberculosis-incidence-in-solid-organ-transplant-recipients-in-europe.pdfFinal published version, 1.4 MBLicence: CC BY

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Lange, B., Brehm, T. T., Arend, S. M., Arias-Guillén, M., Bakker, M., Berastegui, C., Babiker, M., Charif, R., Duarte, R., Flick, H., Hofland, R. W., Ismail, J., Kniepeiss, D., Krepel, J., Krishnan, N., Kuijpers, D. L., Kunst, H., van Leth, F., Lezaic, V., ... Sester, M. (2026). Tuberculosis incidence in solid organ transplant recipients in Europe: A multicenter TBnet cohort study. Journal of infection, 92(1), 106668. Article 106668. https://doi.org/10.1016/j.jinf.2025.106668

@article{67ba7c67b0ea4166893b1851863dac01,

title = "Tuberculosis incidence in solid organ transplant recipients in Europe: A multicenter TBnet cohort study",

abstract = "BACKGROUND: Solid organ transplant (SOT) recipients face elevated tuberculosis risk, yet optimal prevention strategies in low- to medium-incidence regions remain unclear. METHODS: We conducted a multicenter retrospective cohort study of adult SOT recipients transplanted between 2007 and 2012 at 15 European centers, with follow-up through 2018. The primary outcome was microbiologically confirmed post-transplant tuberculosis. Incidence rates were calculated per 100,000 person-years; standardized incidence ratios (SIRs) used World Health Organization country-specific background rates. Cox models assessed risk factors. RESULTS: Among 5805 patients (median age 51; 62.7\% male; 73.9\% renal transplants), 33.8\% were tested for tuberculosis infection and 10.3\% received tuberculosis preventive therapy (TPT). Over 33,785 person-years, 23 patients (0.4\%) developed tuberculosis (68.0/100,000 person-years). Highest incidence occurred in patients with positive screening but no TPT (233.8/100,000). Incidence was higher in Southern vs. Central Europe (251.9 vs. 28.7/100,000), with pooled SIRs of 12.8 and 3.1, respectively. Tuberculosis risk was elevated among Southern European recipients (HR 22.9) and those with migration history (HR 2.7). CONCLUSION: Tuberculosis risk is increased in European SOT recipients. Regionally adapted prevention strategies, including targeted screening in low-incidence areas and universal screening in higher-incidence regions, are warranted.",

keywords = "IGRA, Progression to tuberculosis, TBnet, Transplantation, Tuberculosis",

author = "Berit Lange and Brehm, \{Thomas Theo\} and Arend, \{Sandra M.\} and Miguel Arias-Guill{\'e}n and Marleen Bakker and Cristina Berastegui and Maaz Babiker and Rawya Charif and Raquel Duarte and Holger Flick and Hofland, \{Regina W.\} and Joanna Ismail and Daniela Kniepeiss and Jessica Krepel and Nithya Krishnan and Kuijpers, \{Dora L.\} and Heinke Kunst and \{van Leth\}, Frank and Visnja Lezaic and Ibai Los-Arcos and Jana Machov{\'a} and Heather Milburn and Morais, \{Sandra A.\} and Kon, \{Onn Min\} and Carmen Osoro-Suarez and \{Pessegueiro Miranda\}, Helena and Dragica Pesut and Ananna Rahman and Tomas Reischig and Adri{\'a}n S{\'a}nchez-Montalv{\'a} and Spohn, \{Hanna Elisa\} and Stegenga, \{Merel T.\} and \{de Vries\}, \{Aiko P. J.\} and Dirk Wagner and Rika Wobser and Christoph Lange and Martina Sester",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/",

year = "2026",

month = jan,

day = "1",

doi = "10.1016/j.jinf.2025.106668",

language = "English",

volume = "92",

pages = "106668",

journal = "Journal of infection",

issn = "0163-4453",

publisher = "W.B. Saunders Ltd",

number = "1",

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Lange, B, Brehm, TT, Arend, SM, Arias-Guillén, M, Bakker, M, Berastegui, C, Babiker, M, Charif, R, Duarte, R, Flick, H, Hofland, RW, Ismail, J, Kniepeiss, D, Krepel, J, Krishnan, N, Kuijpers, DL, Kunst, H, van Leth, F, Lezaic, V, Los-Arcos, I, Machová, J, Milburn, H, Morais, SA, Kon, OM, Osoro-Suarez, C, Pessegueiro Miranda, H, Pesut, D, Rahman, A, Reischig, T, Sánchez-Montalvá, A, Spohn, HE, Stegenga, MT, de Vries, APJ, Wagner, D, Wobser, R, Lange, C & Sester, M 2026, 'Tuberculosis incidence in solid organ transplant recipients in Europe: A multicenter TBnet cohort study', Journal of infection, vol. 92, no. 1, 106668, pp. 106668. https://doi.org/10.1016/j.jinf.2025.106668

TY - JOUR

T1 - Tuberculosis incidence in solid organ transplant recipients in Europe

T2 - A multicenter TBnet cohort study

AU - Lange, Berit

AU - Brehm, Thomas Theo

AU - Arend, Sandra M.

AU - Arias-Guillén, Miguel

AU - Bakker, Marleen

AU - Berastegui, Cristina

AU - Babiker, Maaz

AU - Charif, Rawya

AU - Duarte, Raquel

AU - Flick, Holger

AU - Hofland, Regina W.

AU - Ismail, Joanna

AU - Kniepeiss, Daniela

AU - Krepel, Jessica

AU - Krishnan, Nithya

AU - Kuijpers, Dora L.

AU - Kunst, Heinke

AU - van Leth, Frank

AU - Lezaic, Visnja

AU - Los-Arcos, Ibai

AU - Machová, Jana

AU - Milburn, Heather

AU - Morais, Sandra A.

AU - Kon, Onn Min

AU - Osoro-Suarez, Carmen

AU - Pessegueiro Miranda, Helena

AU - Pesut, Dragica

AU - Rahman, Ananna

AU - Reischig, Tomas

AU - Sánchez-Montalvá, Adrián

AU - Spohn, Hanna Elisa

AU - Stegenga, Merel T.

AU - de Vries, Aiko P. J.

AU - Wagner, Dirk

AU - Wobser, Rika

AU - Lange, Christoph

AU - Sester, Martina

N1 - Publisher Copyright: © 2025 The Author(s). Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/

PY - 2026/1/1

Y1 - 2026/1/1

N2 - BACKGROUND: Solid organ transplant (SOT) recipients face elevated tuberculosis risk, yet optimal prevention strategies in low- to medium-incidence regions remain unclear. METHODS: We conducted a multicenter retrospective cohort study of adult SOT recipients transplanted between 2007 and 2012 at 15 European centers, with follow-up through 2018. The primary outcome was microbiologically confirmed post-transplant tuberculosis. Incidence rates were calculated per 100,000 person-years; standardized incidence ratios (SIRs) used World Health Organization country-specific background rates. Cox models assessed risk factors. RESULTS: Among 5805 patients (median age 51; 62.7% male; 73.9% renal transplants), 33.8% were tested for tuberculosis infection and 10.3% received tuberculosis preventive therapy (TPT). Over 33,785 person-years, 23 patients (0.4%) developed tuberculosis (68.0/100,000 person-years). Highest incidence occurred in patients with positive screening but no TPT (233.8/100,000). Incidence was higher in Southern vs. Central Europe (251.9 vs. 28.7/100,000), with pooled SIRs of 12.8 and 3.1, respectively. Tuberculosis risk was elevated among Southern European recipients (HR 22.9) and those with migration history (HR 2.7). CONCLUSION: Tuberculosis risk is increased in European SOT recipients. Regionally adapted prevention strategies, including targeted screening in low-incidence areas and universal screening in higher-incidence regions, are warranted.

AB - BACKGROUND: Solid organ transplant (SOT) recipients face elevated tuberculosis risk, yet optimal prevention strategies in low- to medium-incidence regions remain unclear. METHODS: We conducted a multicenter retrospective cohort study of adult SOT recipients transplanted between 2007 and 2012 at 15 European centers, with follow-up through 2018. The primary outcome was microbiologically confirmed post-transplant tuberculosis. Incidence rates were calculated per 100,000 person-years; standardized incidence ratios (SIRs) used World Health Organization country-specific background rates. Cox models assessed risk factors. RESULTS: Among 5805 patients (median age 51; 62.7% male; 73.9% renal transplants), 33.8% were tested for tuberculosis infection and 10.3% received tuberculosis preventive therapy (TPT). Over 33,785 person-years, 23 patients (0.4%) developed tuberculosis (68.0/100,000 person-years). Highest incidence occurred in patients with positive screening but no TPT (233.8/100,000). Incidence was higher in Southern vs. Central Europe (251.9 vs. 28.7/100,000), with pooled SIRs of 12.8 and 3.1, respectively. Tuberculosis risk was elevated among Southern European recipients (HR 22.9) and those with migration history (HR 2.7). CONCLUSION: Tuberculosis risk is increased in European SOT recipients. Regionally adapted prevention strategies, including targeted screening in low-incidence areas and universal screening in higher-incidence regions, are warranted.

KW - IGRA

KW - Progression to tuberculosis

KW - TBnet

KW - Transplantation

KW - Tuberculosis

UR - https://www.scopus.com/pages/publications/105027119413

U2 - 10.1016/j.jinf.2025.106668

DO - 10.1016/j.jinf.2025.106668

M3 - Article

C2 - 41429410

SN - 0163-4453

VL - 92

SP - 106668

JO - Journal of infection

JF - Journal of infection

IS - 1

M1 - 106668

ER -

Tuberculosis incidence in solid organ transplant recipients in Europe: A multicenter TBnet cohort study

Abstract

UN SDGs

Keywords

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