Lung transplant outcomes in cystic fibrosis patients with pre-operative Mycobacterium abscessus respiratory infections

Clin Transplant. Jul-Aug 2013;27(4):523-9. doi: 10.1111/ctr.12140. Epub 2013 May 26.

Abstract

Background: Mycobacterium abscessus in cystic fibrosis (CF) patients is considered a contraindication to lung transplantation. We examine the post-transplant outcomes of CF patients with M. abscessus pre-transplant.

Methods: CF patients transplanted at the University of North Carolina from 1992 to 2012 were retrospectively examined. Patients with at least one respiratory sample positive for M. abscessus prior to transplantation were included. Data collected included age, FEV1, body mass index (BMI), systemic steroid use, diabetes mellitus, ventilatory assistance, co-existent CF pathogens, imaging, post-transplant complications, and survival. RESULTS (N = 13): At transplant, mean age was 24.6 yr, mean BMI was 18.1 kg/m(2), six had 3+ positive smears for M. abscessus, and three were ventilator dependent. All met American Thoracic Society microbiological criteria for disease pre-transplant. Three patients developed M. abscessus-related complications, with clearance of the organism following treatment. Survival post-transplant shows 77% alive at one yr, 64% at three yr, and 50% at five yr; none died of M. abscessus. The survival data showed no statistically significant difference (p = 0.8) compared with a contemporaneously transplanted population of CF patients without M. abscessus (n = 154).

Conclusion: Lung transplantation, with favorable survival, is possible in CF patients with M. abscessus. Even if M. abscessus recurs, local control and clearance is possible.

Keywords: Mycobacterium abscessus; cystic fibrosis; lung transplantation; non-tuberculous mycobacteria; outcomes.

MeSH terms

  • Adolescent
  • Adult
  • Cystic Fibrosis / microbiology
  • Cystic Fibrosis / mortality*
  • Cystic Fibrosis / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Transplantation / mortality*
  • Male
  • Mycobacterium Infections, Nontuberculous / microbiology
  • Mycobacterium Infections, Nontuberculous / mortality*
  • Mycobacterium Infections, Nontuberculous / surgery
  • Nontuberculous Mycobacteria / pathogenicity*
  • Postoperative Complications*
  • Preoperative Care
  • Prognosis
  • Retrospective Studies
  • Survival Rate
  • Young Adult