Abstract
Mycobacterium abscessus (MABS) is a non-tuberculous mycobacteria (NTM) known to cause life threatening disease involving the lung, skin and soft tissue, and disseminated disease in lung transplantation recipients (LTRs). Therefore, many centres consider the presence of MABS as a relative contraindication to lung transplantation (LT). The goal of this study was to assess the epidemiology and outcomes of MABS infection before and after LT in a pan-Canadian cohort.
We conducted a multicenter retrospective cohort study including all 4 LT centers in Canada. All LTRs transplanted between January 2006 and December 2016 with at least one respiratory sample positive for MABS complex prior to or post transplantation were included. Pulmonary disease was defined using the American Thoracic Society criteria for NTM lung infection. Follow up duration was 5 years after transplantation.
Among a cohort of 2230 LTRs across Canada, 15 patients (0.67%) had MABS infection prior to LT. Median age was 32 (range 17-58), 7/15 (47%) were female and the most common underlying disease was cystic fibrosis 11/15 (73%). Among patients with MABS infection pre-transplant, 80% (12/15) received treatment prior to transplant. Following LT, 53% (8/15) developed recurrent MABS infection (6 disease and 2 colonization). Five-year mortality among patients with pre-transplant MABS infection was 27% (4/15). Among patients with pre-transplant MABS infection, mortality was higher in those who had recurrence of MABS infection after transplant (50% vs 0%, 0.077), though this did not reach statistical significance. Microbiologic eradication prior to transplant occurred in 8/15 (72.7%) and was associated with decreased mortality (0% vs 57.1%, 0.026) and decreased risk of recurrence (12.5% vs 100%, 0.001). In addition to the 8 patients with recurrent disease, 12 patients developed de novo MABS infection after transplant of which 66.7% (8/12) had disease. Among the 14 patients with post-transplant disease, 5 year mortality was 50% (7/14), the majority of which was due to MABS infection (5/7, 71.4%).
MABS is an uncommon cause of infection among LTRs. Recurrence rate among those with pre-transplant infection is high and this may be associated with decreased survival. Survival among those with pre-transplant MABS infection was similar to contemporary cohorts of LTRs.