Mycobacterium abscessus disease in lung transplant recipients: Diagnosis and management

Chandrashekaran, S.; Escalante, Patricio; Kennedy, Cassie C.

doi:10.1016/j.jctube.2017.08.002

Cited by 22 publications

(19 citation statements)

References 52 publications

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“…A potential benefit of early treatment is that reservoirs other than the native lungs, such as the sinuses and the upper airways beyond the anastomosis, could still harbor infection in those with disease pre‐transplant and could contribute to contamination of the new graft. This has been described with mycetomas in the explanted lungs and NTMs like M abscessus …”

Section: Discussionmentioning

confidence: 85%

Granuloma in the explanted lungs: Infectious causes and impact on post‐lung transplant mycobacterial infection

Kabbani

Kozłowski

Cervera

et al. 2020

Transplant Infectious Dis

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Introduction: The significance of granuloma in explanted lungs of lung transplant recipients (LTR) on the development of post-transplant mycobacterial infection is unclear. Methods: A retrospective review comparing LTRs and heart-lung transplant (H-LTR) recipients with granuloma in the explanted lungs between 2000 and 2012 (excluding those LTRs with granuloma due to sarcoidosis) and LTRs or H-LTRs without granuloma. Patients were followed for 2 years post-transplant. Results: A total of 144 LTRs and 4 H-LTRs with granulomas (75 necrotizing and 73 non-necrotizing) and a comparator cohort of 144 LTRs and 4 H-LTRs without granuloma were analyzed. In LTRs with granulomas, identification of infectious organisms was more common by histopathology (35 AFB and 22 fungal) compared to cultures (six NTM and seven fungal) taken around time of the transplant. LTRs with granulomas were more likely to have pre-transplant non-tuberculous mycobacteria (NTM) infection compared to LTRs without granuloma; P < .01. In the multivariate analysis, having granuloma or positive mycobacterial cultures at time of transplant were associated with increased risk of post-transplant mycobacterial infection (HR = 1.8 95% CI [1.024-3.154]; P = .041 and HR = 2.083 95% CI [1.011-4.292]; P = .047). Although there was a trend toward increase mycobacterial disease in those with granulomas P = .056, there was no difference in survival post-transplantation between those with or without granuloma in the explanted lung; P = .886. Conclusion: The presence of granuloma in the explanted lungs of LTRs or positive mycobacterial cultures at time of transplant is associated with an increased risk of mycobacterial infection post-transplant. K E Y W O R D S granuloma, lung transplantation, non-tuberculous mycobacterium

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Section: Discussionmentioning

confidence: 85%

Granuloma in the explanted lungs: Infectious causes and impact on post‐lung transplant mycobacterial infection

Kabbani

Kozłowski

Cervera

et al. 2020

Transplant Infectious Dis

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“…Disease eradication prior to transplant is unlikely. Our findings suggest that the goal of treatment before transplant should be to reduce disease burden as has been suggested previously . We used AFB‐smear negativity as a surrogate but it is not known whether this is the best biomarker of disease burden.…”

Section: Discussionmentioning

confidence: 81%

Management and clinical outcomes after lung transplantation in patients with pre‐transplant Mycobacterium abscessus infection: A single center experience

Perez

Singer

Schwartz

et al. 2019

Transplant Infectious Dis

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Background Preoperative Mycobacterium abscessus infection is often considered a contraindication to lung transplantation because of its association with poor outcomes after transplant. Detailed strategies for bridging to transplant, post‐operative management, and data regarding outcomes are lacking. Methods We reviewed outcomes in subjects with M abscessus infection who underwent lung transplantation between 2010 and 2018 at the University of California San Francisco. M abscessus infection was defined by American Thoracic Society (ATS) criteria. Data collected included age, FEV1, BMI, LAS, antibiotic regimens, and other management decisions. Time to chronic lung allograft dysfunction (CLAD) and survival were also assessed. Results Of 387 lung transplant recipients, seven were infected with M abscessus at the time of listing. All received multiple antibiotics before transplant. While all subjects converted to smear negative for acid‐fast bacilli before listing, five of the seven remained culture‐positive at the time of transplant. After transplant, subjects received a median of 6 months of a multi‐antibiotic regimen. One subject developed a post‐operative M abscessus soft tissue infection that was treated medically. Six of the seven subjects survived the observation period; one died unrelated to M abscessus. Time to CLAD and survival were similar to a contemporary comparator group of CF transplant recipients. Conclusion Lung transplant recipients with M abscessus infection have a low incidence of recurrent infection, excellent survival, and freedom from CLAD when an aggressive management and surveillance strategy is utilized. Given these findings, M abscessus infection may not be considered a contraindication to lung transplantation.

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“…M. abscessus infection infers a significant high risk for lung transplant receptors related to its complex management and traditionally poor outcome [6 ▪▪ ]. M. abscessus treatment is tedious, based on triple/quadruple drug combinations, associated to elevated drug toxicity and frequent relapses due to incomplete or lack of efficacy therapy [7].…”

Section: Nontuberculous Mycobacteria: Mycobacterium Abscessus Complexmentioning

confidence: 99%

Multiresistant organisms: bacteria and beyond

Solé¹

2022

Current Opinion in Organ Transplantation

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Purpose of reviewInfections with multiresistant organisms are an emerging problem, cause early mortality post lung transplantation and are sometimes associated with graft dysfunction. Frequently they raise questions about the selection of lung transplant candidates and therapeutic management post lung transplantation. There are no guidelines and management must be individualized. This review summarizes the available therapeutic options in cases of multidrug-resistant (MDR) organisms and outcomes after lung transplant.Recent findingsImprovements in diagnosis, new and more effective drugs and the experience gained in the management of these infections in lung transplantation, lead to a more optimistic horizon than that found a decade ago.SummaryUpdate on the management of Burkholderia cepacia complex, Mycobacterium abscessus complex, Aspergillus spp., Scedosporium spp. and Lomentospora prolificans infections. This review clarifies current posttransplant outcomes and adds a little hope in these scenarios.

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Mycobacterium abscessus disease in lung transplant recipients: Diagnosis and management

Cited by 22 publications

References 52 publications

Granuloma in the explanted lungs: Infectious causes and impact on post‐lung transplant mycobacterial infection

Granuloma in the explanted lungs: Infectious causes and impact on post‐lung transplant mycobacterial infection

Management and clinical outcomes after lung transplantation in patients with pre‐transplant Mycobacterium abscessus infection: A single center experience

Multiresistant organisms: bacteria and beyond

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