Outcomes in solid organ transplant recipients receiving organs from a donor with Fusarium solani species complex meningitis

Background Five organs (heart, right lung, liver, right, and left kidneys) from a deceased patient were transplanted into five recipients in four US states; the deceased patient was identified as part of a healthcare‐associated fungal meningitis outbreak among patients who underwent epidural anesthesia in Matamoros, Mexico. Methods After transplant surgeries occurred, Fusarium solani species complex, a fungal pathogen with a high case‐mortality rate, was identified in cerebrospinal fluid from the organ donor by metagenomic next‐generation sequencing (mNGS) and fungal‐specific polymerase chain reaction and in plasma by mNGS. Results Four of five transplant recipients received recommended voriconazole prophylaxis; four were monitored weekly by serum (1‐3)‐β‐d‐glucan testing. All five were monitored for signs of infection for at least 3 months following transplantation. The liver recipient had graft failure, which was attributed to an etiology unrelated to fungal infection. No fungal DNA was identified in sections of the explanted liver, suggesting that F. solani species complex did not contribute to graft failure. The remaining recipients experienced no signs or symptoms suggestive of fusariosis. Conclusion Antifungal prophylaxis may be useful in preventing donor‐derived infections in recipients of organs from donors that are found to have Fusarium meningitis. An organ donor was confirmed to have Fusarium solani species complex infection in plasma and cerebrospinal fluid; all five transplant recipients remained asymptomatic with no evidence of fungal infection. Post‐exposure prophylactic intervention could be considered to help prevent donor‐derived infection.