Transplantation infection
Mycobacterium abscessus Infections in Lung Transplant Recipients: The International Experience

https://doi.org/10.1016/j.healun.2006.09.003Get rights and content

Background

The clinical significance of Mycobacterium abscessus infection in the lung transplant population is not well understood.

Methods

An international survey was performed to determine the incidence and clinical outcomes of M abscessus infections before and after lung transplantation.

Results

Thirty-one (50%) of the 62 transplant centers affiliated with the International Society of Heart and Lung Transplantation responded to the survey. Of 5,200 transplants performed, 17 patients (0.33%) (M/F, 12:5) were identified with M abscessus after transplantation. Two patients had respiratory colonization before lung transplantation. Post-transplantation M abscessus infections occurred in the pulmonary allograft in 12, in skin/soft tissue in 3, or both in 2. Median time to diagnosis after transplantation was 18.5 months (range, 1–111 months). Therapies included multiple antibiotics in 16, surgical débridement in 2, interferon-γ in 1, or no therapy owing to presumed colonization in 1. Eleven (73%) of 16 treated patients had a radiologic or microbiologic response to treatment. Concurrent infections were common, with Aspergillus (n = 8) and Pseudomonas aeruginosa (n = 5) most frequently seen. Death in 2 patients was attributed to M abscessus. Ten of 17 patients are alive and considered cured.

Conclusions

M abscessus infection in the lung transplant recipient is uncommon and challenging; however, successful treatment can occur. Prolonged combination anti-microbial therapy is required for pulmonary involvement, and surgical débridement is recommended for cutaneous lesions. Concurrent infections are common and may contribute to mortality in this immunosuppressed population.

Section snippets

Methods

In November 2003, a questionnaire was sent by e-mail or regular mail to 62 transplant centers affiliated with the International Society of Heart and Lung Transplantation registry (Appendix A). As M abscessus was sub-speciated from M chelonae after 1992, only those patients who received transplants after 1992 were included.4 The 2-page questionnaire addressed total program activity and total number of cases of M abscessus infection. Each program used its own procedures to identify cases of M

Survey Response and Incidence

Thirty-one centers (50%) responded (Appendix B). Of a total of 5,200 transplantations performed, 17 patients were identified with M abscessus for a cumulative incidence of 0.33%. Most centers did not report any cases (n = 24), whereas 5 centers reported 1 patient, 1 center reported 4 patients, and our center reported 8 patients. Eleven patients were from North America, 2 were from Europe, and 4 were from Australia. Four of these cases have previously been reported.2, 3 The cumulative incidence

Discussion

This study is, to our knowledge, the first worldwide survey of M abscessus infections in lung transplant recipients. Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that rarely cause disease in immunocompetent individuals. Contact tracing has been deemed unnecessary, as human-to-human transmission is rare.5, 6, 7 As a result, the exact incidence and prevalence of NTM remains unknown. Like several other NTM, M abscessus is generally found in patients with pre-existing

Conclusion

M abscessus is a rare and challenging pathogen in lung transplant recipients. With prolonged combination antimicrobial therapy coupled with surgical débridement for cutaneous lesions, treatment can be successful. Co-existent infections are common, however, and potentially fatal in this vulnerable population.

References (19)

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