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Published on: September 5, 2017
Donor-derived tuberculosis among solid organ transplant recipients in the United States-2008 to 2018
Maricar Malinis1, Ricardo M La Hoz2, Gabriel Vece3
1Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
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.
Insights
Donor-derived tuberculosis (TB) can occur in organ transplant recipients. Evaluating organ donors for TB risk factors is crucial for preventing transmission and ensuring patient survival.
Area of Science:
- Transplantation Immunology
- Infectious Diseases
- Public Health
Background:
- Mycobacterium tuberculosis transmission via organ donation poses severe risks to recipients.
- Donor-derived tuberculosis (DDTB) requires careful monitoring within organ procurement networks.
Purpose of the Study:
- To analyze the incidence and characteristics of DDTB transmissions reported to the Organ Procurement and Transplantation Network (OPTN) between 2008 and 2018.
- To identify risk factors in donors associated with proven or probable DDTB.
- To emphasize the importance of early reporting and intervention for DDTB.
Main Methods:
- Retrospective analysis of all potential DDTB transmissions reported to the OPTN Ad Hoc Disease Transmission Advisory Committee (2008-2018).
- Categorization of transmissions based on recipient diagnosis and donor screening results.
- Review of donor risk factors, recipient diagnosis timelines, clinical presentations, and outcomes.
Main Results:
- Nine out of 51 (17%) reports involved proven/probable DDTB transmissions (9 donors/35 recipients).
- Transmissions occurred in both lung and non-lung recipients, with a median diagnosis time of 104 days post-transplant.
- All donors linked to DDTB had at least one TB risk factor (e.g., endemic country origin, incarceration, latent TB).
Conclusions:
- Donor-derived tuberculosis is a significant concern in organ transplantation.
- Thorough evaluation of organ donors for TB risk factors is essential to prevent transmission.
- Prompt reporting of suspected DDTB cases to OPTN facilitates timely interventions and protects other potential recipients.
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