1536. Donor Derived Mycobacterium tuberculosis Infection after Solid-Organ Transplantation: A Comprehensive Review
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • DDTB_poster.pdf (631.4 kB)
  • Background: Donor derived Mycobacterium tuberculosis (DDTB) has occasionally been reported after solid organ transplantation (SOT).

    Methods: To characterize DDTB, MEDLINE OVID, and EMBASE were reviewed from inception to 12/31/16 using key words donor-derived infection, tuberculosis and solid organ transplant.

    Results: A total of 36 cases of proven (17), probable (8) and possible (11) DDTB were identified among 16 lung, 13 kidney, 6 liver, and 1 heart recipient. Most patients were male (21/35, 60%); median age was 48 (range, 23-68) years. Median time to DDTB was 2.7 (0.2-29) months after SOT. Donor residence in TB-endemic area (13/28, 46.4%) was common. Fever was the most frequent symptom (20/36, 56.5%). DDTB was classified as pulmonary (36%), extra-pulmonary (28%) or disseminated (36%), with common involvement of the allograft (31/36, 86%). Diagnosis was made by smear or culture (30/36, 83.3%). Three (10/24, 41.7%) or four-drug therapy (13/24, 54.2%) was given for median of 10.5 (range, 6-24) months. Graft loss, all-cause and TB-attributable mortality occurred in 18% (4/22), 25 % (9/36) and 44% (4/9), respectively.

    Conclusion: DDTB presents early as febrile illness after SOT, and carries a high mortality risk. Donors should be screened, with particular attention to risk factors.

    Table 1. Summary of Characteristics of Donors & Recipients with DDTB

    CHARACTERISTICS

    N (% or range)

    Age, yr

    48 (23-68)

    Gender, M (N=35)

    21 (60)

    Type of transplant

    Kidney

    Liver

    Lung/Heart-lung

    Heart

    13 (36.1)

    6 (16.7)

    16 (44.4)

    1 (2.8)

    h/o T cell depleting agent (N=9)

    5 (55.6)

    h/o acute rejection (N=19)

    11 (57.9)

    Immunosuppressive regimen w/

    Cyclosporine (N=21)

    8 (38.1)

    Donor Characteristics, N=28

    Deceased

    Living

    Not specified

    24 (85.7)

    2 (7.1)

    2 (7.1)

    Donor Risk Factor for TB^

    Latent or Active TB

    Residence in Endemic country

    Socio-economic~

    None

    5

    13

    5

    5

    Type of TB

    Pulmonary

    Extrapulmonary

    Disseminated

    13 (36.1)

    10 (27.8)

    13 (36.1)

    Type of DDTB

    Proven

    Probable

    Possible

    17

    8

    11

    Clinical presentation (N=33)

    Fever

    Other*

    20 (60.6)

    13 (39.4)

    Time to diagnosis, med in mos

    2.7 (0.2-29)

    Diagnosis, N=34^

    AFB Smear or Culture

    Histopathology

    PCR

    30

    8

    2

    Outcome

    Graft loss or failure (N=22)

    Death

    4 (18)

    9 (25)

    LEGEND:

    * Pain (2), cough/dyspnea (3), Effusion (1), nephritis (1), nausea (1) no symptoms (5),

    NR – not reported

    ^ may have more than one

    ~ Includes homelessness, incarceration, alcohol abuse, and travel

    Cybele Lara Abad, MD, FIDSA, Section of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines and Raymund R. Razonable, MD, FIDSA, Division of Infectious Diseases, Mayo Clinic, Rochester, MN

    Disclosures:

    C. L. Abad, None

    R. R. Razonable, None

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