1536. Donor-Derived Mycobacterium tuberculosis Infection After Solid-Organ Transplantation: A Comprehensive Review

Abstract 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 December 31, 2016 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, six liver, and one 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 and Recipients With DDTBCharacteristicsN (% or range)Age, year48 (23–68)Gender, M (N = 35)21 (60)Type of transplantKidney13 (36.1)Liver6 (16.7)Lung/heart–lung16 (44.4)Heart1 (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 = 28Deceased24 (85.7)Living2 (7.1)Not specified2 (7.1)Donor risk factor for TBaLatent or active TB5Residence in endemic country13Socio-economicb5None5Type of TBPulmonary13 (36.1)Extrapulmonary10 (27.8)Disseminated13 (36.1)Type of DDTBProven17Probable8Possible11Clinical presentation (N = 33)Fever20 (60.6)Otherc13 (39.4)Time to diagnosis, med in months2.7 (0.2–29)Diagnosis, N = 34aAFB smear or culture30Histopathology8PCR2OutcomeGraft loss or failure (N = 22)4 (18)Death9 (25) amay have more than one. bHomelessness, incarceration, alcohol abuse, and travel. cPain (2), cough/dyspnea (3), Effusion (1), nephritis (1), nausea (1) no symptoms (5), NR,–not reported. Disclosures All authors: No reported disclosures.