Characterization of Mycobacterial Findings before and after Lung and Heart-Lung Transplantation

Abstract

<h3>Purpose</h3> Lung and heart-lung transplant candidates and recipients are susceptible to mycobacterial infections that can cause morbidity and mortality. We characterized the incidence, clinical characteristics and treatment of mycobacterial findings and assessed their impact on patient outcomes. <h3>Methods</h3> We conducted a retrospective review of patients who underwent lung or heart-lung transplantation in our center between June 1988 and May 2020 and identified patients with mycobacterial findings, in most cases positive sputum or bronchoscopy sample cultures. Pre-transplant patients are screened for mycobacterial infections with bronchoscopy and sputum samples. Post-transplant patients undergo surveillance bronchoscopies several times during the first post-transplant year, annually thereafter, and when clinically warranted. The decision to initiate anti-mycobacterial treatment is based on clinical, radiologic and mycobacterial sample results, with the aim to treat mycobacterial disease and monitor colonization. <h3>Results</h3> In a cohort of 355 patients, 15/355 (4.2%) patients had a pre-transplant mycobacterial finding and 9/15 received anti-mycobacterial treatment. In one patient, mycobacterium tuberculosis infection recurred post-transplant. No deaths were related to mycobacterial infections in patients with a pre-transplant mycobacterial finding. In post-transplant patients, 27/355 (7.6%) patients had a mycobacterial finding and 5/27 received anti-mycobacterial treatment. One patient died due to disseminated mycobacterium abscessus infection. Mycobacterial findings pre- or post-transplant did not affect overall patient survival compared to non-infected patients (Log Rank p = 0.312). <h3>Conclusion</h3> Mycobacterial findings are rare in patients undergoing lung or heart-lung transplantation, and do not seem to affect overall survival of patients. Most post-transplant mycobacterial findings represent colonization, but disseminated mycobacterial infection may be fatal.