The Role of Nontuberculous Mycobacteria in Patients With Cystic Fibrosis Advanced Lung Disease

Shirin Barcikowski; Ribal Bou Mjahed; Oriol Manuel; Macé M Schuurmans; Adrian Alonso; Zisis Balmpouzis; Jesica Mazza-Stalder; Angela Koutsokera; Nicolas J Mueller

doi:10.1111/tid.70190

The Role of Nontuberculous Mycobacteria in Patients With Cystic Fibrosis Advanced Lung Disease

Transpl Infect Dis. 2026 Feb 25:e70190. doi: 10.1111/tid.70190. Online ahead of print.

Authors

Affiliations

¹ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
² Infectious Diseases Service and Transplantation Center, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
³ Department of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁴ Lung Transplantation Center, Division of Pulmonology, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
⁵ Adult Cystic Fibrosis and CFTR-related Disorders Center, Division of Pulmonology, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.

PMID: 41738587
DOI: 10.1111/tid.70190

Abstract

Background: Despite decreased morbidity and mortality in patients with cystic fibrosis (CF) with CFTR modulators, a significant percentage still develop advanced lung disease. Nontuberculous mycobacteria (NTM) remain challenging pathogens with unclear effects on disease progression and post-transplant outcome.

Methods: NTM-positive patients were identified from all CF patients treated at the University Hospitals of Zurich and Lausanne between 1998 and 2020. Disease course pre- and post-transplant was recorded, and NTM-positive patients were compared to patients without NTM infection for death or lung transplantation, as well as post-transplant survival and development of chronic lung allograft dysfunction (CLAD).

Results: Of 270 patients, 56 (20.7%) met criteria for NTM positivity (two independent cultures with the same organism), with Mycobacterium abscessus complex (MABSC) being the most common species (75.0%). Death or transplantation occurred in 12 of 56 (21.4%) NTM-positive patients and 92 of 198 (46.5%) NTM-negative patients (OR 3.17; 95% CI, 1.53-7.00; p = 0.001). Post-transplant mortality was higher in the NTM-positive cohort (3 (27.3%) vs. 12 (13.0%); HR, 4.01, 95% CI, 1.08-14.86; p = 0.024), while CLAD incidence did not differ significantly.

Conclusion: NTM-positive CF patients were associated with a lower pre-transplant risk of death or transplantation. Post-transplant mortality was higher in NTM-positive patients, while no association between NTM infection and CLAD was observed. These findings indicate that favorable outcomes after lung transplantation are achievable in NTM-positive patients. Thus, NTM-infection should not be an absolute contraindication for lung transplantation, though careful individual assessment is essential due to the risk of serious complications.

Keywords: cystic fibrosis; lung transplantation; nontuberculous mycobacteria.