TRANSMISSION OF INVASIVE ASPERGILLOSIS FROM A SUBCLINICALLY INFECTED DONOR TO 3 DIFFERENT ORGAN TRANSPLANT RECIPIENTS

Objective: To describe a cluster of donor-transmitted cases of invasiv e aspergillosis. Design: Case series of epidemiologically linked cases of invasive aspergillosis. Setting: Two tertiary care centers with so lid-organ transplant programs. Patients: Two kidney recipients, one he art recipient, and the single donor. Measurements: Routine clinical, m icrobiological, and pathologic investigation as dictated for patient c are. Epidemiologic analysis to establish linkage among cases. Results: Three allografts (two kidneys and a heart) from a single donor transm itted invasive aspergillosis to the recipients. Three weeks after tran splantation, the two kidney recipients had fever and urine cultures po sitive for Aspergillus fumigatus. The infected kidneys had multiple As pergillus abscesses and had to be removed to cure the patients. The he art recipient had a negative workup when a diagnosis of aspergillosis was made for the kidney recipients but presented three months later wi th aspergillus endocarditis with recipients. hematogenous spread to th e eyes and to the skin. Treatment included eye surgery, aortic valve r eplacement, and antifungal therapy; control of infection ensued, The d onor was intensely immunosuppressed (17 days post-liver transplantatio n with death from intracerebral bleeding) but had no clinical or autop sy evidence of aspergillosis. Donor tracheal secretions obtained at th e time of organ harvest later grew A fumigatus. Conclusion: Expanded c riteria for organ donation have to be balanced against infectious risk to organ recipients, A fumigatus can be transmitted from a subclinica lly infected donor to solid-organ transplant recipients.