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Updated: Feb 9, 2026
Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation
Published on: October 11, 2024
Solving the mystery: Hyalinized cyst wall containing organism-like structures in a lung transplant donor
Julia Bini Viotti1, Matthias Loebe2, Nicolas Brozzi2
1Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA.
Insights
A heart transplant recipient developed a lung infection from a rare fungus. Prompt diagnosis and antifungal prophylaxis prevented spread to other organ recipients.
Area of Science:
- Transplantation Immunology
- Mycology
- Infectious Diseases
Background:
- Orthotopic heart transplantation is a life-saving procedure for end-stage heart failure.
- Donor selection involves careful risk assessment, including potential infectious disease transmission.
- Immunosuppression post-transplant increases recipient susceptibility to opportunistic infections.
Observation:
- A high-risk donor heart was transplanted into a recipient with non-ischemic cardiomyopathy.
- During organ procurement, a lung nodule was identified, prompting biopsy.
- Bronchoscopy revealed purulent secretions, suggestive of infection.
Findings:
- Lung biopsy identified a hyalinized cyst wall with organism-like structures.
- Microscopic morphology, culture, and gene sequencing identified the causative organism as a rare fungus.
- The patient and other organ recipients received antifungal prophylaxis.
Implications:
- Early identification and treatment of fungal infections are crucial in transplant recipients.
- Risk stratification of organ donors is essential to minimize post-transplant complications.
- Multidisciplinary approaches involving pathology, microbiology, and infectious disease specialists are vital for managing rare infections in transplantation.
Abstract:
A 59-year-old man with non-ischemic cardiomyopathy underwent orthotopic heart transplantation. The donor, a 31-year-old male declared brain dead after a gunshot wound to the head, was considered high risk due to history of incarceration, illicit drug use, and sex with a HIV-positive partner. At organ procurement, the heart, kidneys, pancreas, and liver looked grossly normal. A small right lower lobe nodule was noticed, and lung biopsy was performed. Bronchoscopy showed purulent secretions in the right lower lobe. Images from pathology are presented. Lung biopsy confirmed the presence of hyalinized cyst wall containing organism-like structures. A combination of culture, microscopic morphology, and gene sequencing was used to identify the causative organism. The patient and all other organ recipients received appropriate antifungal prophylaxis and remain asymptomatic 6 months post-transplant.
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