Donor-derived infections in heart and lung transplant recipients

Heart and lung transplantation are life-saving treatments for patients with end-stage organ disease. Donor-derived infections are common and can be expected or unexpected. The lung is exposed to the external environment and transplanted with an intact microbiome, which can include community and nosocomial bacterial, viral, and fungal pathogens. This includes not only well-recognized scenarios, such as bacteria with or without multidrug resistance, respiratory viruses including SARS-CoV-2, molds, and tuberculous/nontuberculous mycobacteria, but also emerging pathogens, such as the mollicutes. The heart is the only transplanted organ that is a muscle and in direct contact with the bloodstream. These factors make donor-derived endocarditis, toxoplasmosis, and Chagas disease particularly relevant. This article aims to review some key established and emerging donor-derived infections that are of particular significance to heart and lung transplant recipients.