BACKGROUND Organ transplantation places patients at risk for tuberculosis (TB), which constitutes a challenge to physicians due to its atypical and extrapulmonary presentations, complicated treatment issues, and high morbidity and mortality. METHODS We identified all patients with TB following solid organ transplantation at a large university medical center in New York. Demographic data, transplant characteristics (type of organ and donor), underlying medical conditions, immunosuppressive drugs, rejection and opportunistic infections were analyzed, and a nested case-control study was performed to identify factors associated with the development of TB. RESULTS From 1988 to 2007, 4925 transplants were performed at Columbia University Medical Center: 1858 kidney, 857 liver, 1714 heart, 460 lung, and 36 heart/lung. Thirteen patients developed TB, for a cumulative incidence of 264/100,000. Of the 13 patients who developed TB, 10 had a kidney transplant, 2 had a lung transplant, and 1 had a heart transplant. The median time to develop TB was 11.2 (interquartile ratio: 4.4-23.0) months following transplantation. These cases were compared with 52 randomly selected control patients who had transplants not complicated by TB. Patients with TB were more likely to be renal transplant recipients (adjusted odds ratio [OR]: 4.59; 95% confidence interval [CI]: 1.07-19.67) and to be non-Caucasians (adjusted OR: 3.94; 95% CI: 0.99-15.56) than controls. CONCLUSIONS The incidence of TB in post-transplant patients is much higher than the overall background incidence in the United States. Non-Caucasian and kidney transplant recipients appear to be at increased risk of developing TB. This may be associated with prior exposure to TB before transplant in these populations.