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

Cybele L.R. Abad, Raymund R Razonable

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
JournalTransplant Infectious Disease
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Mycobacterium Infections
Organ Transplantation
Mycobacterium tuberculosis
Tissue Donors
Tuberculosis
Lung
Fever
Allografts
Transplants
Mortality
Infection
MEDLINE
Epidemiology
Kidney
Liver

Keywords

  • donor derived TB
  • Mycobacterium tuberculosis
  • solid organ transplant

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

@article{d61988942e744572b9b5a162df7103fd,
title = "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 = "donor derived TB, Mycobacterium tuberculosis, solid organ transplant",
author = "Abad, {Cybele L.R.} and Razonable, {Raymund R}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/tid.12971",
language = "English (US)",
journal = "Transplant Infectious Disease",
issn = "1398-2273",
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T1 - Donor derived Mycobacterium tuberculosis infection after solid-organ transplantation

T2 - A comprehensive review

AU - Abad, Cybele L.R.

AU - Razonable, Raymund R

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - donor derived TB

KW - Mycobacterium tuberculosis

KW - solid organ transplant

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