Transmission of lymphocytic choriomeningitis virus by organ transplantation

Staci A Fischer, Mary Beth Graham, Matthew J Kuehnert, Camille N Kotton, Arjun Srinivasan, Francisco M Marty, James A Comer, Jeannette Guarner, Christopher D Paddock, Dawn L DeMeo, Wun-Ju Shieh, Bobbie R Erickson, Utpala Bandy, Alfred DeMaria, Jeffrey P Davis, Francis L Delmonico, Boris Pavlin, Anna Likos, Martin J Vincent, Tara K Sealy, Cynthia S Goldsmith, Daniel B Jernigan, Pierre E Rollin, Michelle M Packard, Mitesh Patel, Courtney Rowland, Rita F Helfand, Stuart T Nichol, Jay A Fishman, Thomas Ksiazek, Sherif R Zaki
New England Journal of Medicine 2006 May 25, 354 (21): 2235-49

BACKGROUND: In December 2003 and April 2005, signs and symptoms suggestive of infection developed in two groups of recipients of solid-organ transplants. Each cluster was investigated because diagnostic evaluations were unrevealing, and in each a common donor was recognized.

METHODS: We examined clinical specimens from the two donors and eight recipients, using viral culture, electron microscopy, serologic testing, molecular analysis, and histopathological examination with immunohistochemical staining to identify a cause. Epidemiologic investigations, including interviews, environmental assessments, and medical-record reviews, were performed to characterize clinical courses and to determine the cause of the illnesses.

RESULTS: Laboratory testing revealed lymphocytic choriomeningitis virus (LCMV) in all the recipients, with a single, unique strain of LCMV identified in each cluster. In both investigations, LCMV could not be detected in the organ donor. In the 2005 cluster, the donor had had contact in her home with a pet hamster infected with an LCMV strain identical to that detected in the organ recipients; no source of LCMV infection was found in the 2003 cluster. The transplant recipients had abdominal pain, altered mental status, thrombocytopenia, elevated aminotransferase levels, coagulopathy, graft dysfunction, and either fever or leukocytosis within three weeks after transplantation. Diarrhea, peri-incisional rash, renal failure, and seizures were variably present. Seven of the eight recipients died, 9 to 76 days after transplantation. One recipient, who received ribavirin and reduced levels of immunosuppressive therapy, survived.

CONCLUSIONS: We document two clusters of LCMV infection transmitted through organ transplantation.

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