In 2022 the largest global outbreak of mpox to date emerged. In the immunocompetent host, mpox is generally presents as a self-limiting illness. However immunosuppression such as that seen with advanced human immunodeficiency virus (HIV) has been associated with significant morbidity and mortality related to mpox infection. To evaluate the impact of immunosuppression related to solid organ transplantation on clinical features and outcomes of mpox we established a multicenter case registry. 11 cases from 7 participating centers in the USA were submitted. All cases occurred in males. The majority were kidney transplant recipients (91%, n=10). Median duration of symptoms at presentation was 6 days (range 3-14 days). Rates of hospitalization were high (73%, n=8) with a median length of stay of 4.5 days (range 1-10). Mpox in solid organ transplant recipients (SOTRs) was associated with a high burden of skin lesions and systemic symptoms. Fever, fatigue, pharyngitis and proctitis were commonly reported. Other clinical features included headache, myalgia, epididymorchitis, urinary retention, hemetemesis, pneumonitis and circulatory shock. All patients received treatment with tecovirimat. There was one mpox related mortality in the cohort. Infection was reported to have resolved at 30 day follow up in all other cases.
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