Nontuberculous Mycobacterial Infection After Lung Transplantation: A Single Center Experience of South Korea

Abstract

Background: Nontuberculous mycobacteria (NTM) infection is an important issue after lung transplantation, but the incidence and mortality data are insufficient. We present our experience with pulmonary NTM infection after lung transplantation. Methods: We retrospectively evaluated the lung transplant recipients between January 2013 and December 2018 in a referral hospital of South Korea. Bronchoscopies were performed according to the surveillance protocol and clinical indications. The diagnosis of pulmonary NTM colonization was defined by a positive NTM culture in a bronchoalveolar lavage specimen or at least two separate sputum samples. NTM pulmonary disease (NTM-PD) was diagnosed according to the American Thoracic Society/Infectious Disease Society of America 2007 guidelines. Log-rank test and Cox regression models were used to assess the relationship between NTM and all-cause mortality. Results: A total of 210 recipients were enrolled. The median age at transplantation was 56 (Interquartile range, IQR 45-63) years, and 61% were males. Fourteen (7%) patients were diagnosed with NTM colonization at a median of 11.8 (IQR 1.7-22.2) months after transplantation. Nine (4%) patients were diagnosed with NTM-PD, and the incidence of NTM-PD was 2,219/100,000 person-year. Mycobacterium abscessus (56%) was the most common species in NTM-PD, followed by M. avium (22%) and M. intracellulare (22%). NTM colonization group had better survival after transplantation (Log-rank P = 0.02) and showed decreased the risk of allcause mortality (HR 0.22, 95% CI 0.06-0.91, P=0.037). NTM-PD group showed no difference in mortality. Conclusions: The incidence of NTM-PD is considerable in lung transplantation recipients. NTM colonized patients had better survival outcomes than the control group after lung transplantation.

Utility of microbiologic testing in surveillance bronchoscopy following lung transplantation: A retrospective cohort study

“…Nontuberculous mycobacterial culture positivity has been reported in 0.46%–4.19% of LTRs; however, studies do not differentiate the rate of colonization versus true infection 23–25 . Our study showed a nontuberculous mycobacterial positivity rate of only 0.7% of 427 tests performed, all of which were deemed colonization, and none led to changes in patient care.…”

Medical Complications of Lung Transplantation

“…The highest proportion (4.2% of patients) had M. abscessus infections, followed by MAC pulmonary disease. These NTM infections did not influence mortality after LT [52]. Nocardia infections after LT are rare, but related to increased mortality.…”

Unusual Presentation of Disseminated Mycobacterium kansasii Infection in Renal Transplant Recipients and Rapid Diagnosis Using Plasma Microbial Cell-free DNA Next-generation Sequencing

“…2-4 Several studies have demonstrated a very low incidence of MK infection (anywhere from none to <1% incidence) in SOT. 5-18 In a 2016 review of NTM in SOT, Abad and Razonable 19 found 304 patients with NTM infection in SOT recipients. 19 Most of NTMs occurred in kidney transplants reflecting a higher relative volume of kidney transplants performed.…”