1392. Tuberculosis Disease in Recipients of Organ-Transplantation, California 2010–2017

BACKGROUND: Tuberculosis (TB) disease in persons who have received organ transplantation causes high morbidity, but the epidemiology and clinical features of this problem remain poorly described. METHODS: Using California TB registry data from 2010–2017, we describe clinical features of all TB cases occurring in patients who previously received solid-organ transplantation. We compared TB cases with and without transplant, and examined mortality controlling for age. RESULTS: During 8 years of observation, the California TB Registry recorded 116 cases of post-transplant TB. A majority of patients with post-transplant TB were >45 year old (84%), nonwhite (90%), and born outside of the United States (84%). Of 116 cases, 48 (41%) had pulmonary disease, while 68 (59%) had extra-pulmonary or both pulmonary and extra-pulmonary disease, compared with 69% and 31%, respectively, in non-transplant-associated TB (P < 0.01). Common sites of extrapulmonary disease in transplant patients included pleura (19%), cervical lymph nodes (12%), and bone (12%). Controlling for age, transplant cases were nearly twice as likely to die as non-transplant-associated TB cases (OR = 1.92, CI = 1.13, 3.25). Among 49 post-transplant TB cases with a positive TB skin test (TST) or interferon-gamma release assay (IGRA), 12 (24%) had the test performed > 6 months prior to TB diagnosis. CONCLUSION: Our findings suggest that post-transplant TB disease is more likely to be extra-pulmonary and result in death than non-transplant-associated TB, and that opportunities may exist for preventing TB disease through screening and treatment for LTBI in this population. DISCLOSURES: All authors: No reported disclosures.