Donor‐derived tuberculosis among solid organ transplant recipients in the United States—2008 to 2018

Abstract

Mycobacterium tuberculosis can be transmitted via organ donation and result in severe outcomes. To better understand donor-derived tuberculosis (DDTB), all potential transmissions reported to the Organ Procurement and Transplantation Network (OPTN) Ad Hoc Disease Transmission Advisory Committee between 2008 and 2018 were analyzed. Among 51 total reports, nine (17%) (9 donors/35 recipients) had ≥ 1 recipient with proven/probable disease transmission. Of these, eight were reported due to recipient disease, and one was reported due to a positive donor result.Proven/probable DDTB transmissions were reported in six lung and five nonlung recipients. The median time to diagnosis was 104 days posttransplant (range 0-165 days).Pulmonary TB, extrapulmonary TB, pulmonary plus extrapulmonary TB, and asymptomatic TB infection with positive interferon-gamma release assay were present in five, three, one, and two recipients, respectively. All recipients received treatment and survived except for one whose death was not attributed to TB. All donors associated with proven/probable DDTB had ≥ 1 TB risk factor. Six were born in a TB-endemic country, five had traveled to a TB-endemic country, three had been incarcerated, and three had latent TB infection. These cases highlight the importance of evaluating donors for TB based on risk factors. Early posttransplant TB in organ recipients of donors with TB risk factors requires prompt reporting to OPTN to identify other potential affected recipients and implement timely treatment interventions.

Donor‐derived endemic mycoses after solid organ transplantation: A review of reported cases

“…Proven infection was defined as clear evidence of the same infection in the donor and at least one of the recipients; probable was defined as strong evidence suggesting but not proving a disease transmission; and a possible case was considered when the data suggest a possible transmission event but are insufficient to fulfill criteria for confirmed transmission, and transmission cannot be formally excluded. 4 Our review was limited to adults, publications in English or English translation. We excluded pediatric cases, and cases of endemic fungi diagnosed prior to transplant.…”

“…We searched titles and abstracts using several databases (EBM Only those meeting criteria for donor-derived infection based on the Disease Transmission Advisory Committee (DTAC) categories related to donor derivation were included and categorized as proven, probable, or possible. 3,4 Definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group were used as a guide as well 5 (Table S1). Proven infection was defined as clear evidence of the same infection in the donor and at least one of the recipients; probable was defined as strong evidence suggesting but not proving a disease transmission; and a possible case was considered when the data suggest a possible transmission event but are insufficient to fulfill criteria for confirmed transmission, and transmission cannot be formally excluded.…”

CAQ Corner: Infections in liver transplant recipients

“…In the US, posttransplant TB is often a result of the reactivation of latent or healed untreated primary infection as opposed to new primary infection. [28] Most post-LT cases occur within the first year after transplant. Patients should be screened for latent TB before LT if they are from or have lived in an endemic area.…”

“…In the US, posttransplant TB is often a result of the reactivation of latent or healed untreated primary infection as opposed to new primary infection 28 . Most post-LT cases occur within the first year after transplant.…”

Nationwide tuberculosis outbreak in the USA linked to a bone graft product: an outbreak report

“…Donor-derived tuberculosis after solid organ transplantation has been well described in high-incidence and low-incidence countries and carries a high mortality risk. 1 , 2 However, Mycobacterium tuberculosis transmission through tissue grafts is rare. Case reports have shown transmission via bone, 3 heart valve, 4 and dura mater 5 grafts.…”