Donor-derived tuberculosis after solid organ transplantation in two patients and a staff member

Abstract

Because of global mobility and migration resulting in a growing diversity of the donor pool, the risk for donor-derived tuberculosis in solid organ transplant recipients becomes more and more relevant, even in countries with a low overall tuberculosis incidence. Here, we describe a case series of donor-derived tuberculosis in 2 of 3 solid organ transplant recipients and one medical staff member in Germany resulting in the death of one recipient. This case series highlights the relevance of this topic to clinicians. It advocates for a better communication between organ procurement organizations and transplant centers regarding donor information and transplant recipient outcome. Furthermore, it underpins the necessity for a standardized critical incident reporting system in the german transplant system to improve short- and long-term recipient's safety, health and survival.

Donor derived Mycobacterium tuberculosis infection after solid‐organ transplantation: A comprehensive review

“…Through December 2016, a total of 22 case reports, 2 case series and 1 cohort reported on 36 cases of proven (n = 17), probable (n = 8), and possible (n = 11) DDTB cases among 16 lung, 13 kidney, 6 liver, and 1 heart recipient.…”

Pediatric heart transplantation from an influenza B–positive donor

“…Donor‐derived infections may be associated with substantial morbidity and even mortality in transplant recipients . Though disease transmission has been well documented in solid organ transplant recipients from a variety of bacteria, fungi, and viruses, the overall incidence of clinically significant transmission has been estimated at 0.2% and is likely lower for hearts as compared to the transplantation of lymphoid dense organs such as lung and intestines . The key to success may be in risk stratification and successful treatment and management of the infectious processes.…”

“…Though confirmed, clinically significant, donor‐derived bacterial infections are rare, both transient bacteremia and colonization of transplanted organs are far more common and likely under‐reported . When this process involves slow‐growing mycobacteria or fungi, however, recipient morbidity and mortality increase significantly . Conversely, bacteria known to cause severe infections (ie, gram‐negative rods) may not preclude organ donation if appreciated prior to transplant, as risk of transmission may be decreased with adequate antibiotic therapy in the donor and the recipient following transplant …”

“…9,12 When this process involves slow-growing mycobacteria or fungi, however, recipient morbidity and mortality increase significantly. 7,9 Conversely, bacteria known to cause severe infections (ie, gram-negative rods) may not preclude organ donation if appreciated prior to transplant, as risk of transmission may be decreased with adequate antibiotic therapy in the donor and the recipient following transplant. 13 While bacterial and fungal transmission is rare, transmission of donor viral processes is relatively common and for some viruses is even expected.…”

Tuberculosis Screening and Treatment in Solid Organ Transplantation

“…Cavitary disease occurs but is less common than other radiographic features; still, upper lobe disease predominates as with immunocompetent patients with pulmonary TB [38,48,49]. Patients with donor-derived TB sometimes present with organ-specific manifestations, for example allograft-related wound dehiscence or abscess due to TB [50,51].…”