Donor-derived tuberculosis in two lung transplant recipients from the same donor; A case report

Donor-derived tuberculosis in two lung transplant recipients from the same donor; A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Donor-derived tuberculosis in two lung transplant recipients from the same donor; A case report Gabriela Dornikova, Breda Lynch, Emer Lee, David Mannion, Erica Duignan, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8853282/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Mycobacterium tuberculosis is a significant opportunistic pathogen in solid organ transplant recipients, primarily due to the chronic immunosuppression. We present two cases of donor-derived tuberculosis from the same donor in the Irish national centre for heart and lung transplantation. Case 1, a woman in her 60s with a history of end-stage chronic obstructive pulmonary disease, underwent a left single-lung transplant. 5 months post-operatively, she presented with fever and dyspnoea. Bronchoalveolar lavage was positive for M. tuberculosis , type 223235331434425153334732, Haarlem lineage. Case 2 was a man in his 60s with history of idiopathic pulmonary fibrosis, who received a right single –lung transplant from the same donor. Following the diagnosis of the first case, he was placed under surveillance 7 months post-transplant. Although asymptomatic, his bronchoalveolar lavage culture was positive for M. tuberculosis 22 months post-surgery. Molecular analysis confirmed that his isolate was identical to that of case 1. Both patients received treatment consisting of rifabutin, isoniazid, ethambutol and pyrazinamide, and remained reasonably well at follow-up. The case of donor-derived tuberculosis is rare in our transplant centre. The described case was the only one in period 2015–2024. A literature review revealed that the problem of donor-derived TB has gained more attention in recent years, since organ transplantation occurs more frequently in TB-endemic regions. In addition, there is also an exponential rise in global mobility that has increased the diversity of the donor pool, even in non-endemic regions. The World Health Organization currently estimates that approximately one-third of the world's population is infected with TB. Bacteriology Molecular Genetics Molecular Epidemiology Infectious Diseases Donor-derived tuberculosis immunosuppression solid organ transplant lung transplant Introduction Mycobacterium tuberculosis (Mtb) is a significant opportunistic pathogen in solid organ transplant recipients, primarily due to the chronic immunosuppression, required to prevent graft rejection [ 1 ]. Donor-derived tuberculosis (TB) is a rare complication following solid organ transplantation, and tuberculosis screening is not a current transplant prerequisite for most donors [ 2 ]. We report two cases of donor-derived TB originating from a single donor at the Irish national centre for heart and lung transplantation. Case 1 A woman in her 60s with a history of end-stage chronic obstructive pulmonary disease (COPD) underwent a left single-lung transplant in August 2016. The patient was a CMV donor-positive/recipient-negative mismatch with a standard cross-match risk. Post-operative immunosuppression included tacrolimus, mycophenolate mofetil, and prednisolone; her pre-operative interferon-gamma release assay (IGRA) was negative. Five months post-transplant, the patient presented with fever and shortness of breath. Chest X-ray (CXR) showed worsening consolidation over three weeks. Computerised tomography (CT) identified new nodules in the upper lobes of both lungs. BAL culture was positive for MTB after 21 days. The isolate was tested in the reference laboratory, using Mycobacterial Interspersed Repetitive Units - Variable Number Tandem Repeats (MIRU-VNTR) test. This revealed type 223235331434425153334732, Haarlem lineage. The patient completed a course of rifabutin and isoniazid (6 months) with ethambutol and pyrazinamide (2 months). She remains clinically stable as of 2025, eight years post-treatment. Case 2 Case 2 was a man in his 60s with history of idiopathic pulmonary fibrosis, who received a right single–lung transplant from the same donor. His immunosuppression consisted of tacrolimus, mycophenolate mofetil, and prednisolone. IGRA was negative pre-operatively. He was discharged home 14 days post-transplant surgery. Following the diagnosis of the first case he underwent six-monthly bronchoscopic surveillance. A CT thorax seven months post-transplant showed multifocal ground-glass changes and tree-in-bud nodularity in the transplanted left upper lobe, near surgical sutures. While initially Mtb-culture negative, a repeat BAL at 11 months post-transplant grew drug-sensitive Mtb. MIRU-VNTR test revealed type 223235331434425153334732, Haarlem lineage – an identical type with the case 1. He received the same antimicrobial regimen as Case 1 and was reported stable at his 2025 review. Donor The donor was a female in her 60s of Irish origin, residing in the West of Ireland, with a history of Alzheimer’s disease. As Ireland is considered a non-endemic region, TB screening was not performed at the time of donation. Discussion The case of donor-derived TB is rare in our transplant centre. The described case was the only one in 10 year period 2015–2024. An estimate from published literature suggests that donor-to-recipient disease transmissions complicate < 1% of all transplant procedures. The problem of donor-derived TB has gained more attention in recent years, since organ transplantation occurs more frequently in TB-endemic regions. [ 3 ]. A Canadian review [ 4 ] reported several consistencies in the literature regarding solid organ transplantation (SOT): SOT recipients are at a 20- to 74-fold increased risk of developing TB; post-transplantation TB is miliary in 33% of cases, and case mortality approaches 30%, especially among patients with graft-versus-host disease, or those receiving corticosteroids or antilymphocytic therapy. The review also found a bimodal time to onset post-transplant, at a median of either nine months or over two years. Rates of active TB in transplant recipients vary worldwide from 0.3 to 15%, depending on the region [ 5 ]. The World Health Organization currently estimates that approximately one-third of the world's population is infected with TB [ 6 ]. Given the substantial morbidity and mortality associated with active TB in lung recipients, it is crucial to come up with an early diagnosis for those with latent or active TB, in order to optimize their treatment. Regular assessment of lower respiratory samples for Mtb, particularly during the 12-month period post-transplant, may be implemented [ 7 ]. Another challenge in managing the cases arises from the interaction between rifampicin and immunosuppressive medications, particularly between rifampicin and calcineurin inhibitors. The use of fluoroquinolones may be essential to mitigate these interactions risks. [ 1 ] Declarations The patients and a legal guardian consented to participate and publish the clinical case. Funding: None Conflicts of interest/Competing interests: Nothing to declare Availability of data and material: The data that support the findings of this study are available from the corresponding author upon a reasonable request. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. References Pérez-Jacoiste Asín MA, López-Medrano F, Aguado JM (2025) Tuberculosis in lung and heart transplant recipients. JHLT Open. ; 11:100398. 10.1016/j.jhlto.2025.100398 . PMID: 41312401; PMCID: PMC12651833 Vega P, Newby R, Bender Ignacio RA, Fisher CE, Oken E, Harbell JW et al (2025) Donor-Derived Tuberculosis in 3 Solid Organ Transplant Recipients from the Same Donor. Open Forum Infect Dis 12(7):ofaf372. 10.1093/ofid/ofaf372 PMID: 40727571; PMCID: PMC12301964 Abad CLR, Razonable RR (2018) Donor derived Mycobacterium tuberculosis infection after solid-organ transplantation: A comprehensive review. Transpl Infect Dis 20(5):e12971. 10.1111/tid.12971 Epub 2018 Aug 12. PMID: 30055041 Rose G (2005) The risk of tuberculosis transmission in solid organ transplantation: Is it more than a theoretical concern? Can J Infect Dis Med Microbiol 16(5):304–308. 10.1155/2005/287460 PMID: 18159565; PMCID: PMC2095042 Winthrop KL, Kubak BM, Pegues DA, Hufana C, Costamagna P, Desmond E et al (2004) Transmission of mycobacterium tuberculosis via lung transplantation. Am J Transplant. ; 4(9):1529-33. 10.1111/j.1600-6143.2004.00536.x . PMID: 15307842 Getahun H, Matteelli A, Abubakar I, Aziz MA, Baddeley A, Barreira D et al (2015) Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J 46(6):1563–1576. 10.1183/13993003.01245-2015 Epub 2015 Sep 24. PMID: 26405286; PMCID: PMC4664608 Cassir N, Delacroix R, Gomez C, Secq V, Reynaud-Gaubert M, Thomas PA et al (2017) Transplanted lungs and the white plague: A case-report and review of the literature. Med (Baltim) 96(13):e6173 PMID: 28353558; PMCID: PMC5380242 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8853282","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":589729408,"identity":"7212c3a5-2113-4e55-a420-3e900d615fd6","order_by":0,"name":"Gabriela Dornikova","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0008-6134-0830","institution":"Mater Misericordiae University Hospital, Dublin","correspondingAuthor":true,"prefix":"","firstName":"Gabriela","middleName":"","lastName":"Dornikova","suffix":""},{"id":589729409,"identity":"036db285-6673-4724-a090-17549370034c","order_by":1,"name":"Breda Lynch","email":"","orcid":"","institution":"Mater Misericordiae University Hospital, Dublin","correspondingAuthor":false,"prefix":"","firstName":"Breda","middleName":"","lastName":"Lynch","suffix":""},{"id":589729410,"identity":"4d58a358-7bbe-4f0e-a7b3-fbed9d4f87b7","order_by":2,"name":"Emer Lee","email":"","orcid":"","institution":"Mater Misericordiae University Hospital, Dublin","correspondingAuthor":false,"prefix":"","firstName":"Emer","middleName":"","lastName":"Lee","suffix":""},{"id":589729411,"identity":"fc801303-a2f7-45ed-9dca-99c7c621c8a9","order_by":3,"name":"David Mannion","email":"","orcid":"","institution":"Mater Misericordiae University Hospital, Dublin","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Mannion","suffix":""},{"id":589729412,"identity":"7a7ae0dd-848e-4a06-8c52-fa2d3e2e0087","order_by":4,"name":"Erica Duignan","email":"","orcid":"","institution":"Mater Misericordiae University Hospital, Dublin","correspondingAuthor":false,"prefix":"","firstName":"Erica","middleName":"","lastName":"Duignan","suffix":""},{"id":589729413,"identity":"3756bb46-350c-4992-ab1b-2df5760b8352","order_by":5,"name":"Tamara Hoban","email":"","orcid":"","institution":"Mater Misericordiae University Hospital, Dublin","correspondingAuthor":false,"prefix":"","firstName":"Tamara","middleName":"","lastName":"Hoban","suffix":""},{"id":589729414,"identity":"42709ea8-ac7b-4119-b7b0-263a652bdb28","order_by":6,"name":"Elaine McAuliffe","email":"","orcid":"","institution":"Mater Misericordiae University Hospital, Dublin","correspondingAuthor":false,"prefix":"","firstName":"Elaine","middleName":"","lastName":"McAuliffe","suffix":""},{"id":589729416,"identity":"468bc4f7-cde9-4069-8b50-0c75c281acd4","order_by":7,"name":"Hortencia Singh","email":"","orcid":"","institution":"Mater Misericordiae University Hospital, Dublin","correspondingAuthor":false,"prefix":"","firstName":"Hortencia","middleName":"","lastName":"Singh","suffix":""},{"id":589729417,"identity":"b9dcf4b7-e36a-4627-8058-efb4b42536de","order_by":8,"name":"Margaret M Hannan","email":"","orcid":"","institution":"Mater Misericordiae University Hospital, Dublin","correspondingAuthor":false,"prefix":"","firstName":"Margaret","middleName":"M","lastName":"Hannan","suffix":""}],"badges":[],"createdAt":"2026-02-11 15:22:13","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8853282/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8853282/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102753382,"identity":"d1ecd2d7-b293-4728-8230-8080be8e75d7","added_by":"auto","created_at":"2026-02-16 09:34:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":255310,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8853282/v1/c748e60c-d2e7-4fc3-a412-61e1c8e1aa91.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eDonor-derived tuberculosis in two lung transplant recipients from the same donor; A case report\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e (Mtb) is a significant opportunistic pathogen in solid organ transplant recipients, primarily due to the chronic immunosuppression, required to prevent graft rejection [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDonor-derived tuberculosis (TB) is a rare complication following solid organ transplantation, and tuberculosis screening is not a current transplant prerequisite for most donors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. We report two cases of donor-derived TB originating from a single donor at the Irish national centre for heart and lung transplantation.\u003c/p\u003e"},{"header":"Case 1","content":"\u003cp\u003eA woman in her 60s with a history of end-stage chronic obstructive pulmonary disease (COPD) underwent a left single-lung transplant in August 2016. The patient was a CMV donor-positive/recipient-negative mismatch with a standard cross-match risk. Post-operative immunosuppression included tacrolimus, mycophenolate mofetil, and prednisolone; her pre-operative interferon-gamma release assay (IGRA) was negative.\u003c/p\u003e \u003cp\u003eFive months post-transplant, the patient presented with fever and shortness of breath. Chest X-ray (CXR) showed worsening consolidation over three weeks. Computerised tomography (CT) identified new nodules in the upper lobes of both lungs. BAL culture was positive for MTB after 21 days. The isolate was tested in the reference laboratory, using Mycobacterial Interspersed Repetitive Units - Variable Number Tandem Repeats (MIRU-VNTR) test. This revealed type 223235331434425153334732, Haarlem lineage. The patient completed a course of rifabutin and isoniazid (6 months) with ethambutol and pyrazinamide (2 months). She remains clinically stable as of 2025, eight years post-treatment.\u003c/p\u003e "},{"header":"Case 2","content":" \u003cp\u003eCase \u003cspan refid=\"FPar1\" class=\"InternalRef\"\u003e2\u003c/span\u003e was a man in his 60s with history of idiopathic pulmonary fibrosis, who received a right single\u0026ndash;lung transplant from the same donor. His immunosuppression consisted of tacrolimus, mycophenolate mofetil, and prednisolone. IGRA was negative pre-operatively. He was discharged home 14 days post-transplant surgery. Following the diagnosis of the first case he underwent six-monthly bronchoscopic surveillance.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eA CT thorax seven months post-transplant showed multifocal ground-glass changes and tree-in-bud nodularity in the transplanted left upper lobe, near surgical sutures. While initially Mtb-culture negative, a repeat BAL at 11 months post-transplant grew drug-sensitive Mtb. MIRU-VNTR test revealed type 223235331434425153334732, Haarlem lineage \u0026ndash; an identical type with the case 1. He received the same antimicrobial regimen as Case 1 and was reported stable at his 2025 review.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDonor\u003c/h2\u003e \u003cp\u003eThe donor was a female in her 60s of Irish origin, residing in the West of Ireland, with a history of Alzheimer\u0026rsquo;s disease. As Ireland is considered a non-endemic region, TB screening was not performed at the time of donation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe case of donor-derived TB is rare in our transplant centre. The described case was the only one in 10 year period 2015\u0026ndash;2024.\u003c/p\u003e \u003cp\u003eAn estimate from published literature suggests that donor-to-recipient disease transmissions complicate\u0026thinsp;\u0026lt;\u0026thinsp;1% of all transplant procedures. The problem of donor-derived TB has gained more attention in recent years, since organ transplantation occurs more frequently in TB-endemic regions. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A Canadian review [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] reported several consistencies in the literature regarding solid organ transplantation (SOT): SOT recipients are at a 20- to 74-fold increased risk of developing TB; post-transplantation TB is miliary in 33% of cases, and case mortality approaches 30%, especially among patients with graft-versus-host disease, or those receiving corticosteroids or antilymphocytic therapy. The review also found a bimodal time to onset post-transplant, at a median of either nine months or over two years.\u003c/p\u003e \u003cp\u003eRates of active TB in transplant recipients vary worldwide from 0.3 to 15%, depending on the region [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The World Health Organization currently estimates that approximately one-third of the world's population is infected with TB [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the substantial morbidity and mortality associated with active TB in lung recipients, it is crucial to come up with an early diagnosis for those with latent or active TB, in order to optimize their treatment. Regular assessment of lower respiratory samples for Mtb, particularly during the 12-month period post-transplant, may be implemented [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother challenge in managing the cases arises from the interaction between rifampicin and immunosuppressive medications, particularly between rifampicin and calcineurin inhibitors. The use of fluoroquinolones may be essential to mitigate these interactions risks. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe patients and a legal guardian consented to participate and publish the clinical case.\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e \u003cp\u003eConflicts of interest/Competing interests: Nothing to declare\u003c/p\u003e \u003cp\u003eAvailability of data and material: The data that support the findings of this study are available from the corresponding author upon a reasonable request.\u003c/p\u003e \u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eP\u0026eacute;rez-Jacoiste As\u0026iacute;n MA, L\u0026oacute;pez-Medrano F, Aguado JM (2025) Tuberculosis in lung and heart transplant recipients. JHLT Open. ; 11:100398. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jhlto.2025.100398\u003c/span\u003e\u003cspan address=\"10.1016/j.jhlto.2025.100398\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 41312401; PMCID: PMC12651833\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVega P, Newby R, Bender Ignacio RA, Fisher CE, Oken E, Harbell JW et al (2025) Donor-Derived Tuberculosis in 3 Solid Organ Transplant Recipients from the Same Donor. Open Forum Infect Dis 12(7):ofaf372. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ofid/ofaf372\u003c/span\u003e\u003cspan address=\"10.1093/ofid/ofaf372\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 40727571; PMCID: PMC12301964\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbad CLR, Razonable RR (2018) Donor derived Mycobacterium tuberculosis infection after solid-organ transplantation: A comprehensive review. Transpl Infect Dis 20(5):e12971. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/tid.12971\u003c/span\u003e\u003cspan address=\"10.1111/tid.12971\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2018 Aug 12. PMID: 30055041\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRose G (2005) The risk of tuberculosis transmission in solid organ transplantation: Is it more than a theoretical concern? Can J Infect Dis Med Microbiol 16(5):304\u0026ndash;308. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2005/287460\u003c/span\u003e\u003cspan address=\"10.1155/2005/287460\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 18159565; PMCID: PMC2095042\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinthrop KL, Kubak BM, Pegues DA, Hufana C, Costamagna P, Desmond E et al (2004) Transmission of mycobacterium tuberculosis via lung transplantation. Am J Transplant. ; 4(9):1529-33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1600-6143.2004.00536.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1600-6143.2004.00536.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 15307842\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGetahun H, Matteelli A, Abubakar I, Aziz MA, Baddeley A, Barreira D et al (2015) Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J 46(6):1563\u0026ndash;1576. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1183/13993003.01245-2015\u003c/span\u003e\u003cspan address=\"10.1183/13993003.01245-2015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003eEpub 2015 Sep 24. PMID: 26405286; PMCID: PMC4664608\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCassir N, Delacroix R, Gomez C, Secq V, Reynaud-Gaubert M, Thomas PA et al (2017) Transplanted lungs and the white plague: A case-report and review of the literature. Med (Baltim) 96(13):e6173 PMID: 28353558; PMCID: PMC5380242\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Mater Misericordiae University Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Donor-derived tuberculosis, immunosuppression, solid organ transplant, lung transplant","lastPublishedDoi":"10.21203/rs.3.rs-8853282/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8853282/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e is a significant opportunistic pathogen in solid organ transplant recipients, primarily due to the chronic immunosuppression. We present two cases of donor-derived tuberculosis from the same donor in the Irish national centre for heart and lung transplantation.\u003c/p\u003e\n\u003cp\u003eCase 1, a woman in her 60s with a history of end-stage chronic obstructive pulmonary disease, underwent a left single-lung transplant. 5 months post-operatively, she presented with fever and dyspnoea. Bronchoalveolar lavage was positive for \u003cem\u003eM. tuberculosis\u003c/em\u003e, type 223235331434425153334732, Haarlem lineage.\u003c/p\u003e\n\u003cp\u003eCase 2 was a man in his 60s with history of idiopathic pulmonary fibrosis, who received a right single –lung transplant from the same donor. Following the diagnosis of the first case, he was placed under surveillance 7 months post-transplant. Although asymptomatic, his bronchoalveolar lavage culture was positive for \u003cem\u003eM. tuberculosis\u003c/em\u003e 22 months post-surgery. Molecular analysis confirmed that his isolate was identical to that of case 1.\u003c/p\u003e\n\u003cp\u003eBoth patients received treatment consisting of rifabutin, isoniazid, ethambutol and pyrazinamide, and remained reasonably well at follow-up. The case of donor-derived tuberculosis is rare in our transplant centre. The described case was the only one in period 2015–2024.\u003c/p\u003e\n\u003cp\u003eA literature review revealed that the problem of donor-derived TB has gained more attention in recent years, since organ transplantation occurs more frequently in TB-endemic regions. In addition, there is also an exponential rise in global mobility that has increased the diversity of the donor pool, even in non-endemic regions. The World Health Organization currently estimates that approximately one-third of the world's population is infected with TB.\u003c/p\u003e","manuscriptTitle":"Donor-derived tuberculosis in two lung transplant recipients from the same donor; A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 09:14:57","doi":"10.21203/rs.3.rs-8853282/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"114acca7-cc39-47b8-b333-f49d380752f2","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":62752099,"name":"Bacteriology"},{"id":62752100,"name":"Molecular Genetics"},{"id":62752101,"name":"Molecular Epidemiology"},{"id":62752102,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2026-02-16T09:14:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 09:14:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8853282","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8853282","identity":"rs-8853282","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}