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

Abstract

Background: Mycobacterium tuberculosis may be transmitted via the allograft to cause a morbid and potentially fatal infection after solid organ transplantation (SOT). We reviewed all reported cases of donor-derived tuberculosis (DDTB) to provide an update on its epidemiology, clinical course, and outcome after SOT.

Methods: MEDLINE, OVID, and EMBASE were reviewed from its inception until December 31, 2016 using key words donor-derived infection, tuberculosis and solid organ transplant or transplantation.

Results: We retrieved 36 cases of proven (n = 17), probable (n = 8), and possible (n = 11) DDTB among 16 lung, 13 kidney, 6 liver, and 1 heart recipients. Most patients were male (21/35, 60%) with median age of 48 (range 23-68) years. Median time to clinical presentation or diagnosis was 2.7 months (range 0.2-29). The most common donor risk factor was residence in a TB-endemic area (13/28, 46.4%). Fever was the most frequent presenting symptom (20/36, 56.5%). Diagnosis of tuberculosis was mostly made via AFB smear or mycobacterial culture (30/36, 83.3%). Allograft involvement was expectedly common; there were almost equal proportions of pulmonary (36%), extra-pulmonary (28%) and disseminated (36%) cases. All cases of pulmonary TB were identified only among lung transplant recipients. The median duration of TB treatment was 10.5 (range 3-24) months. Graft loss occurred in four (4/22, 18.2%) patients. All-cause mortality was 25% (9/36); four of nine deaths were attributed to TB.

Conclusions: Donor-derived TB presents early after SOT, most commonly as fever, and carries a high mortality risk. Donors should be screened, with particular attention to TB risk factors. Fever during the early post-operative period should prompt a thorough evaluation for DDTB in endemic regions and among patients with "at-risk" donors.

Keywords: Mycobacterium tuberculosis; donor derived TB; solid organ transplant.