Celiac Disease Associated With Nearly Threefold Higher Risk of Solid Organ Transplantation

Patients with celiac disease (CeD) may face a substantially increased risk of solid organ transplantation, particularly liver transplantation, according to a nationwide population-based cohort study from Sweden.

Although celiac disease has been linked to chronic liver, kidney, and cardiovascular conditions, the risk of progression to end-stage organ disease requiring transplantation has remained unclear. To investigate this question, researchers analyzed data from ESPRESSO, a nationwide Swedish histopathology cohort.

The study included 41,277 individuals with biopsy-confirmed CeD diagnosed between 2000 and 2023 and 196,863 age- and sex-matched comparators from the general population. Participants were followed for a mean of 12.1 years.

During follow-up, 85 solid organ transplantations occurred among patients with CeD, corresponding to an incidence rate of 17.0 per 100,000 person-years. In the comparator group, 111 transplantations occurred, with an incidence rate of 4.6 per 100,000 person-years.

Overall, CeD was associated with a significantly increased risk of solid organ transplantation, with an adjusted hazard ratio (HR) of 2.76 (95% CI, 1.96-3.89).

The elevated risk was driven primarily by liver transplantation. Patients with CeD had more than a sevenfold higher risk of liver transplantation than matched controls (HR, 7.26; 95% CI, 3.88-13.56). Kidney transplantation risk was also increased (HR, 1.85; 95% CI, 1.11-3.10).

A higher risk of heart transplantation was observed numerically, but the association did not reach statistical significance (HR, 2.35; 95% CI, 0.84-6.61).

According to the investigators, “CeD was associated with an almost 3-fold increased risk of solid organ transplantation, particularly liver transplantation.” The authors noted that additional research is needed “to explore the pathophysiological relationship between CeD and end-stage organ disease.”

Reference
Doyle J, Lebwohl B, Soderling J, et al.Risk of solid organ transplantation in individuals with celiac disease: a nationwide cohort study. Clinical Gastroenterology and Hepatology. 2026; DOI: 10.1016/j.cgh.2026.04.034