Transmission of mycobacterium tuberculosis via lung transplantation.
Organ donors are not routinely screened for tuberculosis (TB) in the United States. We investigated a case of pulmonary TB in a double-lung transplant recipient. We reviewed the donor's and recipient's records, and used molecular methods to compare the lung recipient's isolate with others from three sources: her hospital, the California state health department's genotyping database, and the donor's resident-nation of Guatemala. A respiratory specimen obtained from the lung recipient 1 day after transplantation grew Mycobacterium tuberculosis. Donor chest radiograph had a previously unnoticed pulmonary opacity that was present on post-transplant recipient chest radiographs and computed tomographs. The recipient's isolate was molecularly distinct from others at her hospital and in the state database, but was identical to two isolates from Guatemala. Tuberculosis was transmitted from lung donor to recipient. As organ transplantation becomes more common worldwide, similar cases could occur. Screening for TB in potential organ donors should be considered.
Winthrop
Kevin L
KL
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA. kwinthro@dhs.ca.gov
Kubak
Bernard M
BM
Pegues
David A
DA
Hufana
Catherine
C
Costamagna
Pam
P
Desmond
Ed
E
Sanders
Cynthia
C
Shen
Paul
P
Flores-Ibarra
Laura
L
Osborne
Eugene
E
Bruckner
David
D
Flood
Jennifer
J
D002140:California; D005260:Female; D006166:Guatemala; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D016040:Lung Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D013902:Radiography, Thoracic; D014019:Tissue Donors; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000635:transmission*