Donor derived coccidioidomycosis (cocci) has been a significant cause of unexpected morbidity and mortality in transplant recipients. Most cases are reported from OPTN region 5. We review all cocci cases reported to the DTAC.
All reports of potential donor derived transmission events (PDDTE) to DTAC between 2008 and August, 2012 were searched for cocci infection. Cocci was diagnosed based on any positive serology testing or positive histology/pathology findings in the donor or recipient.
Between 2008 and August 2012, DTAC investigated 14 PDDTE for transmission of cocci. One of these cases involved a living donor. 6 of 14 PDDTE (43%) were classified as proven (5) or probable (1). In 4 of 6, the infection was first detected in the recipient, and in 2 cases it was first identified in the donor. Twenty-one recipients received organs from these 6 donors. Transmission occurred in 9 of 21 (43%) recipients at a median of 30 days (range 6-64); 6 of these 9 (67%) developed fungal dissemination. Recipients cocci-related mortality was 28.5% (6 of 21). Eleven recipients received fungal prophylactic/treatment, 7 did not receive treatment, and treatment information was not reported for the remaining 3 recipients. The indication to start antifungal treatment in 10 was because other recipients from same donor developed cocci, and in 1 after remote cocci infection to prevent reactivation. With a minimum of four months follow-up on all recipients, 5 of 7 who did not receive prophylactic/treatment expired and the 11 who received antifungal therapy all survived. One of the 3 with unknown treatment died from cocci infection, while the other two survived. The six deaths occurred 14 to 55 days after transplant with a median of 21 days. Five of 6 proven/probable donors and all but three of all reported cases were from OPTN region 5.
Donor derived cocci is a significant cause of morbidity and mortality following transplantation. Evidence of infection in one recipient should prompt immediate evaluation and consideration of treatment of all other recipients from the same donor. Further studies are needed to decide whether all donors in endemic areas (e.g.OPTN region 5) should have routine serology testing.
To cite this abstract in AMA style:Kusne S, Taranto S, Convington S, Kaul D, Bell W, Biggins S, Blumberg E, DeStefano G, Dominguez E, Ennis D, Gross T, Klassen-Fischer M, Kotton C, Law Y, Menegus M, Miller R, Pavlakis M, Pruett T, LaPointe D, Ruiz P, Siparsky N, Souter M, Weiss L, Wolfe C, Green M. Transmission of Coccidioidomycosis through Organ Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/transmission-of-coccidioidomycosis-through-organ-transplantation/. Accessed November 19, 2017.
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