Fischer SA et al. (2006) Transmission of lymphocytic choriomeningitis virus by organ transplantation. N Engl J Med 354: 2235–2249

A report published in the New England Journal of Medicine describes the transmission of lymphocytic choriomeningitis virus (LCMV)—a rodent-borne, Old World arenavirus—by solid organ transplantation.

In 2003, a group of four solid organ transplant recipients presented with unusual symptoms, including diarrhea, altered mental status, fever, respiratory insufficiency, leukopenia or leukocytosis, thrombocytopenia, coagulopathy and graft dysfunction, during the first few weeks post-transplantation. In 2005, another group of four solid organ transplant recipients presented with similar symptoms. Each group had a common deceased donor and included two kidney, one lung and one liver recipient. All eight recipients were found to be infected with LCMV. Identical virus strains were identified in two recipients in the 2003 cluster and in all recipients in the 2005 cluster. Extensive laboratory testing of multiple tissues and serum from both donors did not reveal evidence of LCMV. The 2005 donor had had contact with a pet hamster that was infected with an LCMV strain identical to that found in the 2005 recipients. The source of infection in the 2003 donor is unknown. Seven of the recipients died within 76 days of transplantation. One recipient survived following administration of ribavirin and reduction of immunosuppressant dose.

Up to 5% of adults in the US have been infected with LCMV, but symptoms are usually absent or mild. Intensive immunosuppression, however, makes LCMV infection potentially fatal in transplant recipients. Available assays are not sufficiently sensitive to screen potential donors for all transmissible infections. Clinicians should, therefore, look out for unusual symptoms in solid organ transplant recipients and use information on the donor's exposure to animals to detect donor-transmitted infections.