1534. Donor Derived Tuberculosis (TB) Infection In a Lung Transplant Despite Following Recommended Algorithm for Screening and Management of Deceased Donor Candidates
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: A 58 y/o man (case patient) with negative tuberculin skin test (TST) underwent a double lung transplant in July of 2012 for COPD.  The deceased-donor (Donor X), a 42 year old Vietnamese man who immigrated to the United States (US) in 1988, had died of an acute intracranial hemorrhage. Two day ante-mortem CT chest showed no infiltrates or granulomas in the lungs. No TB prophylaxis was administered to the case patient based on American Society of Transplantation (AST) guidelines on diagnosis and management of TB in transplant donors (AJT 2012; 12: 2297). The case patient developed a cough with a right pulmonary infiltrate on day 90. He underwent bronchoscopy with bronchoalveolar lavage which grew pan-susceptible Mycobacterium tuberculosis.

Methods: The Organ Procurement Organization (OPO) was contacted to identify other organ recipients. The TB isolate was sent to Ohio Department of Health and Center for Disease Control (CDC) for genotyping.

Results: There were three other transplant recipients from Donor X:  1) a kidney recipient with a negative Interferon-Gamma Release Assay (IGRA) and negative urine mycobacterial surveillance cultures who was placed on isoniazid (INH) prophylaxis; 2) a kidney recipient with negative work-up for painful pyuria who was started on INH prophylaxis; 3) a liver recipient with a negative TST who was not placed on prophylaxis. The genotype did not match any TB isolates previously reported in Ohio and the lineage was an Indo-Oceanic strain. CDC investigation revealed that thirty cases matching the spoligotype have been reported in the US, 29 of which were among foreign born persons from Vietnam or Cambodia.

Conclusion: Prophylaxis to prevent donor derived TB infections in lung transplant recipients should be considered even when imaging is negative for latent or active TB when deceased donors are from high endemic areas for TB. The country of origin of deceased donors should be included in the medical record of the recipient.

Dheeraj Kumar, MD1, Marie Budev, DO, MPH2, Mary Diorio, MD, MPH3, Maureen Murphy-Weiss, BSN, RN, CPM3, Walter Hellinger, MD4, Steven Gordon, MD, FIDSA, FSHEA1 and J. Walton Tomford, MD1, (1)Infectious Disease, Cleveland Clinic, Cleveland, OH, (2)Lung Transplantation Center, Cleveland Clinic, Cleveland, OH, (3)Ohio Department of Health, Columbus, OH, (4)Infectious Disease, Mayo Clinic Jacksonville, Jacksonville, FL

Disclosures:

D. Kumar, None

M. Budev, None

M. Diorio, None

M. Murphy-Weiss, None

W. Hellinger, None

S. Gordon, None

J. W. Tomford, None

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