Purpose Coccidioidomycosis (CI) occurs in 4-9% of solid organ recipients in endemic areas, resulting in 30-63% mortality. CI can be transmitted directly via transplantation, but donor CI prevalence and mortality attributable to donor-derived transmission is unclear. A better understanding of risk factors for donor-derived transmission and a point-of-donation CI assay are needed for effective donor screening.

Methods We conducted a retrospective cross-sectional study from Jan. 2014 – Feb. 2016 for all potential organ donors at Donor Network West, an organ procurement organization serving California and Nevada. We determined CI prevalence by positive medical history, positive serology, and/or organ biopsy. We compared survival in recipients with organs obtained from CI+ and CI- donors, and analyzed recipient outcomes from all donors. We assessed bronchoalveolar lavage (BAL) RT-PCR as a rapid screening tool for CI exposure. Data from medical social history questionnaires was used to determine risk factors for donor CI infection.

Results 11/654 potential donors (1.7%) were CI+. 7/11 became donors, providing 26 organs for 22 recipients. 6/22 recipients (27.3%) died post-transplantation. 3/6 deceased recipients had definitive evidence of fungal infection and their deaths were likely related to CI transmission. Of 643 CI- potential donors, 600 actual donors provided 1936 organs for 1738 recipients. 78 died post-transplant (4.5%). Recipients of CI+ donors had significantly higher mortality than recipients of CI- donors (OR 8.0, 95% C.I. 3.0-21.0, p<0.0001). Prison time (OR 2.97, C.I. 0.77–11.5), residence in endemic region (OR 3.7, C.I. 1.1-12.9), and calcifications on chest imaging (OR 28.4, C.I. 4.8-166) were associated with prior CI infection in donors. BAL RT-PCR did not detect CI even in confirmed cases of infection.

Conclusions CI infection in organ donors is associated with significantly higher mortality in recipients. History of incarceration, calcifications on imaging, and residence in endemic regions are potential risk factors for donor-derived transmission. Targeted screening of donors with these characteristics may mitigate transmission even in areas with low donor CI prevalence.

CITATION INFORMATION: Jeyakumar N, Neidlinger N, Salvatore M, Brown C, Carpenter T, Fung M, Chin-Hong P. High Mortality in Transplant Recipients Associated with Coccidioidomycosis Derived from Organ Donors. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress