Risk factors for and outcomes following early acquisition of Mycobacterium abscessus complex after lung transplantation

Abstract

Abstract Background Lung transplant recipients are at increased risk of Mycobacterium abscessus complex (MABC) acquisition and invasive infection. We analyzed risk factors and outcomes of early post-lung transplant MABC acquisition. Methods We conducted a retrospective matched case-control study of patients who underwent lung transplant from 1/1/2012–12/31/2021 at a single large tertiary care facility. Cases had de novo MABC isolation within 90 days post-transplant. Controls had no positive MABC cultures and were matched 3:1 with cases based on age and transplant date. Recipient demographics and pre-/peri-operative characteristics were analyzed, and a regression model was used to determine independent risk factors for MABC acquisition. We also assessed one-year post-transplant outcomes, including mortality. Results Among 1,145 lung transplants, we identified 79 cases and 237 matched controls. Post-transplant mechanical ventilation for >48 hours was independently associated with MABC acquisition (Adjusted OR, 2.46 [95% CI, 1.29–4.72]; P = .007). Compared to controls, cases required more days of hospitalization after the MABC index date (28 vs. 12 days; P = .01) and had decreased one-year post-transplant survival (78% vs. 89%; Log rank P = .02). One year mortality appeared highest for cases who acquired M. abscessus subsp. abscessus (31% mortality) or had extrapulmonary infections (43% mortality). Conclusions In this large case-control study, prolonged post-transplant ventilator duration was associated with early post-lung transplant MABC acquisition, which in turn was associated with increased hospital days and mortality. Further studies are needed to determine the best strategies for MABC prevention, surveillance, and management.