Non-tuberculous mycobacterium infection after lung transplantation is associated with increased mortality

Abstract

BACKGROUND Pulmonary non-tuberculous mycobacterial (NTM) infection is relatively common after lung transplantation, but the effect on mortality remains undetermined. Herein we describe our experience with pulmonary NTM infection after lung transplantation and hypothesized that non-tuberculous mycobacterial infection after lung transplantation would be associated with increased mortality. METHODS We retrospectively evaluated 201 primary lung transplant recipients transplanted between January 2000 and August 2006. Serial bronchoscopies with bronchoalveolar lavage and transbronchial biopsy were performed according to a surveillance protocol and when clinically indicated. The diagnosis NTM infection was established by a positive NTM culture in a bronchoalveolar lavage sample or in at least two separate expectorated sputum samples. NTM infections were further classified as “disease” or “colonization,” based on whether or not NTM infection patients developed symptoms and characteristic radiographic findings. RESULTS Thirty-six (18%) recipients were diagnosed with pulmonary NTM infection at a median of 97 days post-transplantation: 9 were classified as NTM disease and the remaining 27 as NTM colonization cases. Single lung transplant was a significant risk factor for NTM infection (HR 2.25, p = 0.02). NTM colonization was a risk factor for NTM disease (HR 8.39, p = 0.003). NTM infection significantly increased the risk of death after lung transplantation (HR 2.61, p = 0.001) and persisted in multivariate models controlling for single lung transplant and bronchiolitis obliterans syndrome. The increased risk was seen for both NTM colonization and NTM disease. Among the patients who died, non-NTM infection was a more common contributing factor in the cause of death for the NTM infection group (44% vs 12%, p = 0.04). CONCLUSIONS Non-tuberculous mycobacterial infection is common after lung transplantation. NTM colonization and treated acute rejection are risk factors for NTM disease. NTM infection is associated with increased risk of mortality independent of bronchiolitis obliterans syndrome.

British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD)

“…In a study of 201 lung transplant recipients, 36 (18%) isolated NTM following the procedure,329 with 75% of isolations deemed to be infection only and 25% disease by ATS/IDSA criteria. NTM infection was associated with an increased risk of death (HR 2.61) in multivariate models, but the cause of death in this series was due to infections other than NTM.…”

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

“…M. abscessus in particular is challenging to treat and may be associated with rapid clinical deterioration and poor outcomes after lung transplantation. [231][232][233] A multicenter prospective study conducted more than a decade ago showed no association between M. abscessus and decline in lung function, 102 but a longer single-center study showed that chronic M. abscessus infection was associated with an excess decline of 0.78% predicted FEV 1 per year. 66,234 …”

NonTuberculous Mycobacteria Infection and Lung Transplantation in Cystic Fibrosis: A Worldwide Survey of Clinical Practice

“…Extensive and elaborate infection control measures have been recommended to prevent such transmission events [14]. The likely low number of patients post-transplant with NTM is also a possible explanation for the lower number of centres segregating post-transplant [18,20].…”