22.12.2025
Increased Risk of Tuberculosis After Organ Transplantation in Europe
A European multicenter study shows that recipients of solid organ transplants (SOT) face a markedly increased risk of tuberculosis even in countries with low to medium tuberculosis incidence. The findings underscore the need for differentiated, regionally tailored strategies for disease prevention.
For this cohort study, researchers from the Tuberculosis Network European Trials Group (TBnet) analyzed more than 5,800 adult transplant recipients from 15 transplant centers in eight European countries. TBnet is a non-profit, non-governmental organization dedicated to tuberculosis research and is based at the Research Center Borstel.
In this study, 23 confirmed cases of tuberculosis occurred, corresponding to an incidence of 68 cases per 100,000 person-years—around six times higher than in the general population. The risk was particularly pronounced in Southern Europe, where the tuberculosis incidence among organ transplant recipients was 252 cases per 100,000 person-years, approximately nine times higher than in Central Europe and comparable to the tuberculosis incidence in Pakistan. The standardized incidence ratio (SIR) was 12.8 in Southern Europe, compared with 3.1 in Central Europe. In addition, patients with a history of migration had a significantly increased risk of developing tuberculosis.
A key finding of the study relates to preventive practice: only about one third of transplant recipients were screened for latent tuberculosis infection (TBI) prior to transplantation, and only one in ten received preventive therapy. The highest tuberculosis incidence was observed among individuals with a positive screening result who did not receive preventive treatment. This confirms the importance of untreated latent infections as a major cause of post-transplant tuberculosis.
It was also striking that most tuberculosis cases occurred more than two years after transplantation. This suggests that, in addition to reactivation of latent infections, new infections acquired after transplantation play a relevant role. The authors conclude that a uniform approach to tuberculosis prevention in Europe is insufficient.
Kontakt
Dr. med. Thomas Theo Brehm FG Klinische Infektiologie
Forschungszentrum Borstel, Leibniz Lungenzentrum
Parkallee 35
23845 Borstel
Dr. Thomas Theo Brehm, scientist in the Clinical Infectious Diseases research group and physician at the University Medical Center Hamburg-Eppendorf (UKE), is one of the first authors of the study. He explains: “In regions with very low incidence, targeted tuberculosis screening of risk groups may be appropriate, whereas in regions with higher incidence, universal screening and consistent preventive therapy are recommended.” Professor Christoph Lange, Medical Director at the Research Center Borstel and one of the senior authors of the study, adds: “In such settings, patients who are severely immunocompromised after transplantation should also be regularly monitored for signs of new tuberculosis infection.” Together, Lange and Brehm lead the Clinical Tuberculosis Center within the German Center for Infection Research (DZIF), which from 2026 will receive approximately one million euros in public funding for a further five years.
Publikation: 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 D, Kunst H, van Leth F, Lezaic V, Los-Arcos I, Machová J, Milburn H, Morais SA, Min Kon O, 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*. Tuberculosis incidence in solid organ transplant recipients in Europe: A multicenter TBnet cohort study. J Infect 2025 (in press) *equal contribution