Emma Hitt, PhD

March 18, 2008

March 18, 2008 (Atlanta) — Organs transplanted from a donor with disseminated tuberculosis (TB) resulted in disease transmission to 2 of 3 organ recipients, according to a study presented here at the International Conference on Emerging Infectious Diseases 2008.

These findings represent the first TB transmission through transplantation documented by matching genotype isolates of donor and recipients, according to Emily Piercefield, MD, DVM, EIS, officer with the Acute Disease Service for the Oklahoma State Department of Health..

The donor in the study had a history of homelessness and alcohol use and was hospitalized for cerebral vasculitis. He had no known history of TB, and previous tuberculin skin tests had been negative.

The donor's liver and 2 kidneys were transplanted to 3 recipients. One of the kidney recipients died after receiving the transplant, and the other kidney recipient developed disseminated TB. The TB genotype matched that of the donor. No evidence of TB was found in the patient receiving the liver transplant.

"Clinicians should maintain a high index of suspicion for TB when caring for transplant recipients," Dr. Piercefield told Medscape Infectious Diseases. "Identification of risk factors for TB in a potential donor should prompt further investigation to exclude the presence of tuberculosis in that donor candidate," she said.

Matthew Kuehnert, MD, director of the Office of Blood, Organ, and other Tissue Safety, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, who participated in the investigation, noted that recipients of transplants are often immunosuppressed, and therefore, "signs and symptoms can be vague and atypical. For lung transplant patients, classic evidence of TB, such as a cough, may be evident, but for recipients of other organs, such as the kidneys, the patient may only have fever and bone marrow dysfunction," he said. "A bone marrow biopsy may enable identification of Mycobacterium tuberculosis," he added. 

A surveillance system called the Transplantation Transmission Sentinel Network is being developed by the United Network for Organ Sharing, the CDC, and other organizations to aid in the recognition of transmitted disease in recipients, Dr. Kuehnert noted.

"Evidence supporting transplantation as the route of transmission ranges from circumstantial (ie, development of TB in the transplanted organ within a few months of transplantation) to well-established (ie, 2 recipients of a single donor's organs both developing disease through genotypically identical M tuberculosis, of which there have been 2 previous reports [4 prior recipients from 2 donors])," said Gregory Rose, MD, from the Division of Infectious Diseases, Ottawa Hospital, Ontario.

"The current report adds to this literature by providing evidence that the TB strain in the recipients was genotypically identical to that in the donor and contains the strongest evidence to date that TB may be transmitted through a transplanted organ," he told Medscape Infectious Diseases.

Dr. Rose added that some tests, such as mycobacterial cultures, may not be reported until weeks after the transplantation. "This does not mean the transplant should be delayed or cancelled, but [it] does indicate the need for a mechanism for rapid communication of donor TB status to the recipient's transplant care team."

The investigation was conducted and funded by the Oklahoma State Department of Health, the Texas Department of State Health Services, and the CDC. The authors state that the findings and conclusions have not been formally disseminated by the CDC and should not be construed to represent any agency determination or policy. The authors and commentators have disclosed no relevant financial relationships.

International Conference on Emerging Infectious Diseases 2008: Slide Session J3.Presented March 18, 2008.

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