Abstract: SA-PO1146
One Donor, Many Organs, One Culprit: Donor-Derived Mycobacterium Abscessus After Kidney Transplantation
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Yunas, Samia, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Arwani, Suneel, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Vaitla, Pradeep, The University of Mississippi Medical Center, Jackson, Mississippi, United States
- Shahid, Shahzad, The University of Mississippi Medical Center, Jackson, Mississippi, United States
Introduction
Donor-derived infections are rare but serious complications of solid organ transplantation. Mycobacterium abscessus a rapidly is difficult to diagnose as microbiologic studies are initially negative and treatment requires prolonged multidrug therapy. Clinicians must balance infection control with preservation of allograft function while minimizing immunosuppression. Reports involving transmission to multiple organ recipients from a single donor are rare.
Case Description
A 55-year-old woman with end-stage renal disease underwent deceased donor kidney transplantation with early post-transplant course complicated by persistent peri-allograft fluid collections requiring repeated drainage procedures. Initial acid-fast bacilli stains and mycobacterial cultures remained negative. Over time, she developed persistent graft incision site pain and drainage with cultures growing Mycobacterium abscessus ultimately. Donor-derived transmission became evident after liver, lung and another kidney recipient from the same donor were also diagnosed with M. abscessus infection. The other kidney recipient reportedly lost the allograft.
Pt required multidrug therapy with imipenem, amikacin and clofazimine. Course was complicated by severe nausea, leukopenia, CMV viremia, persistent wound pain, nephrotic-range proteinuria, and worsening renal function concerning for aminoglycoside nephrotoxicity, requiring close therapeutic drug monitoring and temporary interruption of amikacin therapy. Immunosuppression was reduced and tacrolimus was transitioned to belatacept-based regimen. Despite prolonged hospitalization and antimicrobial therapy; the allograft function has remained stable.
Discussion
This case highlights the morbidity and diagnostic challenges associated with donor-derived Mycobacterium abscessus infection. Persistent postoperative symptoms with initially negative microbiologic studies delayed diagnosis. Recognition of infection among multiple recipients from the same donor was critical. Management required close collaboration among transplant nephrology, infectious diseases and transplant surgery to coordinate antimicrobial therapy, monitor drug toxicities, reduce immunosuppression and preserve allograft function. This case highlights the importance of maintaining a high index of suspicion for rare donor-derived infections in transplant recipients with persistent postoperative complications.