Risk of Solid Organ Transplantation in Individuals With Celiac Disease: A Nationwide Cohort Study.

BACKGROUND & AIMS: Celiac disease (CeD) is associated with chronic diseases of the liver, kidney, and heart. Despite this, the risk of severe disease requiring transplantation has not been established. Our objective was to measure the risk of solid organ transplantation in individuals with celiac disease relative to that of the general population.

METHODS

This was a population-based matched cohort study in Sweden. We identified individuals with biopsy-proven celiac disease diagnosed between 2000 and 2023 using the nationwide histopathology cohort, ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden). We calculated the incidence of solid organ transplantation (liver, heart, kidney, and lung) in patients with celiac disease and estimated the risk relative to the general population using Cox proportional hazards models. In secondary analyses, we estimated the risk of liver, heart, and kidney transplants specifically.

RESULTS

We identified 41,277 individuals with celiac disease and 196,863 age- and sex-matched comparators. During a mean follow-up of 12.1 years, there were 85 solid organ transplantations in patients with celiac disease (17.0 per 100,000 person-years) and 111 in matched comparators (4.6 per 100,000 person-years). This corresponded to an adjusted hazard ratio of 2.76 (95% confidence interval, 1.96-3.89). There was a significantly increased risk of liver transplantation (hazard ratio, 7.26; 95% confidence interval, 3.88-13.56) and kidney transplantation (hazard ratio, 1.85; 95% confidence interval, 1.11-3.10), but the hazard ratio for heart transplantation did not attain statistical significance (hazard ratio, 2.35; 95% confidence interval, 0.84-6.61).

CONCLUSIONS

In this nationwide study, celiac disease was associated with an almost 3-fold increased risk of solid organ transplantation, particularly liver transplantation. Further research is needed to explore the pathophysiological relationship between celiac disease and end-stage organ disease.