Introduction: Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis, with high global prevalence and elevated death rate without treatment. The risk of TB in solid organ recipients is 74% higher than in the general population. The donor-derived infection corresponds to a minor proportion of these infections but can impact morbidity and mortality after transplantation.
Method: Case report of a central nervous system TB infection in the organ donor, unknown at the donation, with a consequent TB transmission to the kidney and liver recipients.
Results: During follow-up, both kidney transplant recipients presented asymptomatic leukocyturia and were diagnosed with urinary TB infection confirmed by rapid molecular assay. They received treatment with four drugs (isoniazid + rifampin + pyrazinamide + ethambutol) for nine months, with a complete resolution of the disease after treatment. One of the kidney transplant recipients was diagnosed with antibody-mediated rejection and received treatment with intravenous immunoglobulin without reactivation of TB infection. The kidney transplant recipients remained with functioning grafts after a four-year follow-up. The TB infection was detected in the liver recipient on day 21 after transplantation. There were numerous non-caseating epithelioid granulomas at liver biopsy, with a positive TB molecular test and positive acid-fast bacilli on the Ziehl-Neelsen stain. This patient received treatment with four drugs (isoniazid + rifampin + pyrazinamide + ethambutol) for nine months without adverse events. The receptor has been doing well during the four-year follow-up.
Conclusion: Timely detection and treatment of donor-derived TB demonstrated successful clinical and graft-related outcomes, highlighting the importance of continuous monitoring of symptoms for long-term graft viability and patient survival.