Celiac disease patients in Sweden are nearly three times more likely to undergo solid organ transplantation than the general population, a new study from researchers at Columbia University and the Karolinska Institutet has found.
Liver transplantation was particularly pronounced, with a 7-fold greater rate in celiac patients compared to the general population, while kidney transplantation was nearly twice as common in celiac disease patients. No association was found between celiac disease and heart transplantation, possibly because few heart transplants occurred during the study period.
"The especially high rate of liver transplantation we found suggests that clinicians should screen celiac disease patients for liver problems and chronic liver disease," says the study's first author, John Doyle, assistant professor of medicine at Columbia University Vagelos College of Physicians and Surgeons and a physician at Columbia University's Celiac Disease Center.
Previous studies have shown that individuals with celiac disease are at increased risk of liver disease (including both immune-related conditions and metabolic liver disease), chronic kidney disease, and cardiovascular disease. Doyle worked with investigators at the Karolinska Institutet in Sweden to determine if people with celiac disease also have a higher rate of end-stage organ failure requiring organ transplantation.
"We had noted that a number of our patients seen at the Celiac Center at Columbia University had undergone liver and kidney transplants," says Doyle. "We approached our collaborators at the Karolinska Institutet to see if these anecdotal observations were reflective of a trend at the population level."
The study looked through the health records of 41,000 celiac disease patients in Sweden, representing all individuals diagnosed with celiac disease in Sweden between the years 2000 and 2023. These patients were compared to over 196,000 individuals from the general Swedish population. The researchers followed each patient for an average 12 years after diagnosis.
In addition to the higher rates of liver and kidney transplantation, the researchers found:
- Men with celiac disease were more likely to receive a transplant than women with celiac disease
- People diagnosed in their 60s or later had a nearly 7-fold higher rate of organ transplantation than similarly aged people in the general population.
- People with celiac disease had a 2.3-fold increased risk of organ transplant than their siblings without celiac disease, suggesting that celiac disease drives increased risk beyond genetic and environmental influences.
"It's not clear whether celiac disease itself drives the increased risk of organ transplantation, or if comorbid conditions found in celiac disease patients, such as autoimmune hepatitis, are causing more frequent transplant rates," says Doyle.
"More research should help us identify what lies behind the connection so we can intervene and reduce our patients' development of end-stage organ failure."
