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Adverse Occurrence type:
Time to detection:
2 - 5 months
Alerting signals, symptoms, evidence of occurrence:
Case 1: Five months after lung transplant, the recipient developed 2 weeks of malaise followed by acute shortness of breath and bilateral pulmonary infiltrates with a nodule and patchy infiltrate. Case 2: Two months after lung transplant, the asymptomatic patient had a BAL showing AFB and culture grew M. tuberculosis with a new right upper lobe pulmonary nodule and atelectasis that cavitated the next month. Case 3: Three months after bilateral lung transplant, a routine BAL showed growth of pan-sensitive M. tuberculosis. The patient was asymptomatic. At four months postop BAL showed 4+ AFB and a new right upper lobe pulmonary nodule.
Demonstration of imputability or root cause:
Three lung recipients were TST-negative prior to transplant but developed active TB; whereas, none of the three organ donors had evidence of TB. Each of the three patient's TB isolates were identical with TB found in the country where two donors had lived (case 1 and 3), or identical to that found in a TB outbreak near where the donor had lived and had been imprisoned (case 2). This is indirect evidence of acquiring TB from the organ donors. This data does not exclude community acquisition by the recipient.
The correct reference citation is: Mortensen E, Hellinger W, Keller C, Cowan LS, Shaw T, Hwang S, Pegues D, Ahmedov S, Salfinger M, Bower WA. Three cases of donor-derived pulmonary tuberculosis in lung transplant recipients and review of 12 previously reported cases: opportunities for early diagnosis and prevention. Transpl Infect Dis. 2014 Feb;16(1):67-75.