Outcomes of a Peri- and Postoperative Management Protocol for Non-TB Mycobacteria in Lung Transplant Recipients

Abstract

Owing to advanced respiratory disease among lung transplant (LTX) candidates, some could develop nontuberculous mycobacteria-pulmonary disease (NTM-PD). However, the appropriate management of NTM-PD found at the time of LTX is not clear. We, therefore, established a management protocol for peri-transplant NTM-PD, defined by the presence of granulomas and mycobacteriologic evidence of NTM in the explant. Between 2013 and 2014, 230 LTX recipients (LTRs) who survived >30 days post LTX were followed up to 2017. Of these, 7.8% (18/230) LTRs were diagnosed with peri-transplant NTM-PD and treated with Azithromycin 250mg/day, Ethambutol 15mg/kg/day and Moxifloxacin 400mg/day for 12 months according to the protocol. There was no significant difference in the incidence of post-transplant NTM-PD (p=0.362), chronic lung allograft dysfunction (p=0.530) and mortality (p=0.152) between LTRs with/without peri-transplant NTM-PD as long as being managed with anti-mycobacterial drugs during the early phase of post-transplantation. Patients with NTM-PD other than Mycobacterium abscessus diagnosed at the time of LTX were safely managed and did not experience significantly higher rates of post-transplant NTM-PD.