Table 2:

Donor-derived cases of LCMV in solid organ transplant recipients

Year, Location	Donor risk factors and testing	Cause of donor death	Organ donated	Onset of symptoms post-transplant	Symptoms	Recipient testing	Treatment	Outcome
2003 Wisconsin9,94,95	No risk factors identified. Neg IHC staining (heart, stomach, tongue, thyroid, kidney, prostate, cerebral cortex, midbrain, pons, medulla, cerebellum, spinal cord); Neg IgM and IgG (serum); Neg viral culture (serum, bone marrow and blood vessel)	Head trauma/subdural hematoma	Kidney	Day 5	Abdominal pain, fever, watery diarrhea, seizures, polymyoclonus	Pos IHC staining; neg IgM and IgG; pos viral culture	IS stopped, IVIG	Death on day 53 post-transplant
			Kidney	Day 22	Fever, leukopenia, peri-incisional erythema and tenderness, AMS, and seizures	Pos IHC staining; pos IgM; neg IgG; pos virus isolation	IS stopped, cidofovir, IVIG	Death on day 76 post-transplant
			Liver	Early post-operatively	Fever, lethargy, hypotension, marked elevation of liver enzymes, respiratory failure, peri-incisional rash	Pos IHC staining. Serologies and virus isolation not performed	None	Death on day 17 post-transplant
			Lung	Day 4	Hypotension, bilateral pulmonary infiltrates, leukocytosis, fever, hypoxia	Pos IHC staining. Serologies and virus isolation not performed	None	Death on day 9 post-transplant
2005 Rhode Island and Massachusetts9	Infected pet hamster. Neg IHC staining (CNS, heart, spleen, liver, pancreas, uterus, thyroid, gastrointestinal tract, muscle, skin, kidney); neg RT-PCR; neg IgM and IgG (blood and serum); neg viral culture	Right MCA stroke/IC hemorrhage	Kidney	Day 17	Allograft tenderness, nausea, anorexia, diarrhea, fever, chills, erythema over allograft	Pos IHC stain (colon, kidney); pos RT-PCR; pos IgM; neg IgG; pos viral culture	IS stopped, IV ribavirin started day 26, followed by PO ribavirin for a total of 37 days	Survived
			Kidney	Day 17	Fever, allograft tenderness, lethargy, erythema over allograft, hepatitis	Pos IHC staining; pos RT-PCR; pos IgM; neg IgG; pos viral culture	None	Death on day 23 post-transplant
			Liver	Early post-operatively	Headache, fever, abdominal and right shoulder pain, leukopenia, thrombocytopenia, elevation of liver enzymes, seizure	Pos IHC staining; pos RT-PCR; neg IgM; neg IgG; pos viral culture	High dose methylprednisolone and antithymocyte globulin due to concern for rejection	Death on day 26 post-transplant
			Lung	Day 3	Delirium, leukocytosis, thrombocytopenia, fever, pulmonary infiltrates, abdominal pain, respiratory distress	Pos IHC staining; pos RT-PCR; neg IgM and IgG; pos viral culture	High dose methylprenisolone for concern for rejection	Death on day 23 post-transplant
2007 Australia11	None identified. Neg RT-PCR (serum, spleen, pancreas); pos IgM and IgG (serum)	IC hemorrhage	Kidney	Not described	Fever, sepsis, encephalopathy, acute tubular necrosis, graft rejection, chest infiltrates	Pos RT-PCR (plasma, CSF, urine, multiple tissues); neg IgM and IgG	None	Death on day 36 post-transplant
			Liver	Not described	Fever, confusion, encephalopathy, myoclonus, chest infiltrates	Pos RT-PCR (plasma, serum, bronchoalveolar lavage), neg RT-PCR (CSF); pos IgM and IgG	None	Death on day 30 post-transplant
			Kidney	Not described	Fever, graft rejection, encephalopathy	Pos RT-PCR (serum); neg IgM and IgG	None	Death on day 29 post-transplant
2008 Massachusetts8	No risk factors identified. Pos IgM and IgG (serum)	Seizure, fever	Kidney	3 weeks	Lethargy, anorexia, fever, shock, hepatic insufficiency, multisystem organ failure	Pos IHC staining; pos PCR; pos virus isolation	Not described	Death on day 28 post-transplant
			Kidney	2 weeks	Fever, severe hepatitis, multisystem organ failure	Pos IHC staining; pos PCR (whole blood); pos IgM (serum); virus isolation	IS stopped, IVIG, ribavirin 6 weeks after transplant	Death at 10 weeks post-transplant
2011 Arkansas10	Possible rodent exposure. Pos RT-PCR (lymph node), neg IgM and IgG (serum)	Diabetic ketoacidosis, possible meningitis	Kidney	1 week	Fever, nausea, vomiting, diarrhea, severe headache, fever, respiratory failure 3 weeks post-transplant	Pos RT-PCR (BAL); neg IgM and IgG	None	Death on day 30 post-transplant
			Kidney	Day 2	Fever, myalgia, severe headache, nausea, vomiting	Pos RT-PCR (CSF); neg IgM and IgG (CSF)	Reduction of IS, IV acyclovir for aseptic meningitis, concern for herpes simplex	Survived
			Liver	Day 20	Atrial fibrillation, AMS, elevated liver enzymes	Pos IHC staining (liver); pos RT-PCR (liver, serum); pos IgM and neg IgG (serum); virus isolation (serum)	Reduction of IS	Survived
			Lung	Day 10	Chills, dyspnea, fatigue, abdominal pain, nausea, vomiting, hepatitis	Pos IHC staining; pos RT-PCR (lung, liver)	None	Death on day 20 post-transplant
2013 Iowa12	No risk factors identified. Pos RT-PCR (aortic endothelial cells)	IC hemorrhage	Cornea	N/A	Asymptomatic	Neg RT-PCR, neg IgM and IgG	None	Survived
			Liver	Day 18–22	Fever, abdominal pain, diarrhea, AMS, respiratory compromise	Pos RT-PCR; pos IgM	Reduction of IS, IV ribavirin on day 39, IVIG	Death on day 47 post-transplant
			Kidney	Day 18–22	Fever, abdominal pain, diarrhea, AMS	Pos RT-PCR; pos IgM	Reduction of IS, oral ribavin on day 38	Survived, mild memory deficits
			Kidney	Day 18–22	Fever, abdominal pain, diarrhea, AMS, respiratory compromise	Pos RT-PCR; pos IgM	Reduction of IS, IV ribavin on day 39, IVIG	Survived, memory deficits, allograft failure

Abbreviations: AMS, altered mental status; BAL, bronchoalveolar lavage; CNS, central nervous system; CSF, cerebrospinal fluid; IC, intracranial; IHC, immunohistochemistry; IS, immunosuppression; LCMV, lymphocytic choriomeningitis virus; MCA, middle cerebral artery; neg, negative; PCR, polymerase chain reaction; pos, positive; RT, reverse-transcriptase