Donor-derived tuberculosis in two lung transplant recipients from the same donor; A case report

Mycobacterium tuberculosis is a significant opportunistic pathogen in solid organ transplant recipients, primarily due to the chronic immunosuppression. We present two cases of donor-derived tuberculosis from the same donor in the Irish national centre for heart and lung transplantation. Case 1, a woman in her 60s with a history of end-stage chronic obstructive pulmonary disease, underwent a left single-lung transplant. 5 months post-operatively, she presented with fever and dyspnoea. Bronchoalveolar lavage was positive for M. tuberculosis , type 223235331434425153334732, Haarlem lineage. Case 2 was a man in his 60s with history of idiopathic pulmonary fibrosis, who received a right single –lung transplant from the same donor. Following the diagnosis of the first case, he was placed under surveillance 7 months post-transplant. Although asymptomatic, his bronchoalveolar lavage culture was positive for M. tuberculosis 22 months post-surgery. Molecular analysis confirmed that his isolate was identical to that of case 1. Both patients received treatment consisting of rifabutin, isoniazid, ethambutol and pyrazinamide, and remained reasonably well at follow-up. The case of donor-derived tuberculosis is rare in our transplant centre. The described case was the only one in period 2015–2024. A literature review revealed that the problem of donor-derived TB has gained more attention in recent years, since organ transplantation occurs more frequently in TB-endemic regions. In addition, there is also an exponential rise in global mobility that has increased the diversity of the donor pool, even in non-endemic regions. The World Health Organization currently estimates that approximately one-third of the world's population is infected with TB.