Background: Invasive aspergillosis (IA) is a rare but serious complication in solid organ transplant (SOT) recipients, potentially arising from donor-derived infections. The transmission of these infections (overt, latent, or unrecognized) via an infected donor or during allograft retrieval is uncommon. This study reviews 31 previously reported cases and introduces three new cases originating from a pediatric donor. To the best of our knowledge, this is the first report that focuses on donor-derived fungal infections from a pediatric donor.
Methods: A detailed review of 31 previously published cases from 1971 to 2023 was conducted, along with the presentation of three new cases of IA in kidney and liver transplant recipients from a pediatric donor at our center. Searches were performed across PubMed (MEDLINE), EBSCO, SCOPUS, and Web of Science databases using MeSH (Medical Subject Headings) keywords "donor-derived," "aspergillosis," and "fungal infections." The study included individual case reports and case series. We analyzed donor risk factors, types of transplants, the onset and symptoms of infection, and clinical outcomes, encompassing both patient and graft survival following antifungal therapy.
Results: In our cases, one of the trio of organ recipients, who received donations from the same donor, was 17 years old. The donor, also 17, had a prolonged history of ICU admissions and immunosuppressive treatments. By integrating our three cases with an additional 31 published cases, we determined that the mean ± SD age of the patients was 46.2 ± 16.3 (min-max: 17-77) years, with males comprising 58.8% and females 41.2%, predominantly involving kidney transplant recipients (91.2%). Donor-related risk factors included prolonged ICU stays (31.8%), transplant tourism (31.8%), and immunosuppression (27.3%). The median time to symptom onset post-transplant was 23 (IQR: 16-60) days. Cadaver donors were involved in 76.5% of the cases. The most common symptoms included fever (50.0%) and renal failure (44.1%), with other presentations such as graft-site tenderness (17.6%) and iliac artery pseudoaneurysm (14.7%). Aspergillus spp. accounted for 55.8% of infections in transplant recipients, followed by Mucor spp. (17.6%) and Cryptococcosis (11.8%). Amphotericin B was the primary antifungal treatment in 67.6% of the cases. Biopsies confirmed fungal infection in 88.2% of the cases. Graft explantation was necessary in 70.6% of cases. Of the recipients, 79.4% survived, whereas 20.6% died due to complications related to the infection.
Conclusion: There is a need for heightened clinical vigilance for IA in SOT recipients, particularly in those with fever and abnormal imaging. This study highlights the importance of prompt diagnosis and the implementation of effective antifungal therapy to mitigate the risk of severe complications and enhance survival in this high-risk patient group.