Mycobacterium tuberculosis DNA in living donor transplanted livers and donor‐related tuberculosis in recipients: A retrospective longitudinal cohort study

Abstract

Objectives Mycobacterium tuberculosis DNA has been detected in multiple organs in people without active tuberculosis or a history of tuberculosis. Molecular testing for metabolic activity has suggested that M tuberculosis DNA represents viable bacilli. Whether transplanted organs with M tuberculosis DNA can result in tuberculosis in recipients has not been assessed. Methods Biopsies obtained at the time of living donor liver transplantation were tested for the presence of M tuberculosis DNA using in situ PCR. The cohort of recipients was longitudinally followed for the development of tuberculosis. Results Living donor liver transplantation was performed for 270 patients. Mean age was 33 years (median: 41 years, range: 1‐80 years). Recipients were followed for a mean of 68 months (median: 72 months, range: 1‐138 months) after transplantation. Mycobacterium tuberculosis DNA was detected in 25 of 155 donated livers (16%) with liver biopsies available for testing. None of the recipients of these livers received tuberculosis chemoprophylaxis and only one (4%) developed tuberculosis 15 months after transplantation. Among the entire cohort of 270 patients, post‐transplant tuberculosis was diagnosed in four patients (1.48%) at an incidence rate of 2.61 cases per 1000 transplant‐years. No factors associated with developing tuberculosis were identified, including positive M tuberculosis DNA in transplanted livers. Conclusions Mycobacterium tuberculosis DNA in living donor transplanted livers did not result in tuberculosis despite post‐transplant immunosuppression.

Disseminated tuberculosis in a lung transplant recipient presenting as tenosynovitis, subcutaneous nodules, and liver abscesses

“… 5 , 19 The risk of developing TB post-transplant from a living donor with LTBI is not well established and some studies suggest it may not be significant. 20 , 21 …”

“…5,19 The risk of developing TB posttransplant from a living donor with LTBI is not well established and some studies suggest it may not be significant. 20,21 The mechanism of acquisition of infection in this patient is not clear. Recipient pretransplant screening was notable for a negative interferon gamma release assay (QuantiFERONTB Gold Plus), absence of risk factors for TB, and resi dency in a low prevalence area.…”

Mycobacterium tuberculosis in solid organ transplant donors and recipients

“…Utility of routine molecular testing of deceased donor organ tissue is unclear. Data is limited to a single study that evaluated living donors who underwent liver biopsies before donation [41 ▪▪ ]. Of the 270 donated livers, 155 had available tissue for in-situ polymerase chain reaction (PCR), and 25 (16%) had detectable MTB DNA.…”