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

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. DISCLOSURES: All authors: No reported disclosures.