To evaluate the association between biopsy-confirmed celiac disease and the rate of solid organ transplantation in a nationwide cohort.
Key Findings:
Patients with celiac disease had a higher incidence of solid organ transplantation (17.0 vs 4.6 per 100,000 person-years), although the absolute risk remained low.
Adjusted hazard ratio for solid organ transplantation in celiac disease was 2.76.
Liver transplantation showed the strongest association (adjusted hazard ratio 7.26).
Kidney transplantation was also more common among celiac patients (adjusted hazard ratio 1.85).
Heart transplantation did not show a statistically significant association.
The association was stronger in male patients and those diagnosed at age 60 or older.
Interpretation:
The study indicates a higher relative rate of solid organ transplantation among patients with celiac disease, particularly for liver and kidney transplants, but the absolute risk remains low.
Limitations:
Observational study design cannot establish causality.
Lack of data on specific indications for transplantation.
No data on gluten-free diet adherence.
Potential misclassification and surveillance bias.
Findings may not be generalizable to non-Nordic countries.
Increased risk of transplantation before celiac disease diagnosis may also be influenced by undiagnosed celiac disease.
Conclusion:
Patients with celiac disease are more likely to undergo solid organ transplantation than matched comparators, especially for liver transplants. Further research is needed to explore underlying mechanisms and the impact of celiac disease management on transplant risk.
