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Analysis of pulmonary non‐tuberculous mycobacterial infections after lung transplantation
Author(s) -
Shah S.K.,
McAnally K.J.,
Seoane L.,
Lombard G.A.,
LaPlace S.G.,
Lick S.,
Dhillon G.S.,
Valentine V.G.
Publication year - 2016
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12546
Subject(s) - medicine , lung transplantation , mycobacterium abscessus , nontuberculous mycobacteria , mycobacterium kansasii , mycobacterium chelonae , sputum , bronchiolitis obliterans , univariate analysis , lung , bronchoalveolar lavage , immunology , tuberculosis , mycobacterium , pathology , multivariate analysis
Purpose Non‐tuberculous mycobacteria ( NTM ) are important pathogens in lung transplant recipients. This study describes the spectrum of NTM respiratory tract infections and examines the association of NTM infections with lung transplant complications. Methods Data from 208 recipients transplanted from November 1990 to November 2005 were analyzed. Follow‐up data were available to November 2010. Lung infection was defined by bronchoalveolar lavage, sputum, or blood cultures in the appropriate clinical setting. All identified NTM respiratory tract infections were tabulated. The cohort of patients with NTM lung infections ( NTM +) were compared to the cohort without infection ( NTM −). Univariate and multivariate analysis was performed to determine characteristics associated with NTM infection. Survival analyses for overall survival and development of bronchiolitis obliterans syndrome ( BOS ) were also performed. Results In total, 52 isolates of NTM lung infection were identified in 30 patients. The isolates included M ycobacterium abscessus (46%), M ycobacterium avium complex ( MAC ) (36%), M ycobacterium gordonae (9%), M ycobacterium chelonae (7%), and M ycobacterium fortuitum (2%), with multiple NTM isolates seen on 3 different occasions. The overall incidence was 14%, whereas cumulative incidences at 1, 3, and 5 years after lung transplantation were 11%, 15%, and 20%, respectively. Comparisons between the NTM + and NTM − cohorts revealed that NTM + patients were more likely to be African‐American and have cytomegalovirus mismatch. Although no difference was seen in survival, the NTM + cohort was more likely to develop BOS (80% vs. 58%, P = 0.02). NTM + infection, however, was not independently associated with development of BOS by multivariate analysis. Conclusion With nearly 20 years of follow‐up, 14% of lung recipients develop NTM respiratory tract infections, with M . abscessus and MAC more commonly identified. M . gordonae was considered responsible for nearly 10% of NTM infections. Although survival of patients with NTM infections is similar, a striking difference in BOS rates is present in the NTM + and NTM − groups.