Risk Factors for Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients: A Multinational Case-Control Study

Abstract

Background Risk factors for nontuberculous mycobacteria (NTM) infections after solid organ transplant (SOT) are not well characterized. Here we aimed to describe these factors. Methods Retrospective, multinational, 1:2 matched case-control study that included SOT recipients ≥12 years old diagnosed with NTM infection from January 1, 2008, to December 31, 2018. Controls were matched on transplanted organ, NTM treatment center, and post-transplant survival greater than or equal to the time to NTM diagnosis. Logistic regression on matched pairs was used to assess associations between risk factors and NTM infections. Results Analyses included 85 cases and 169 controls; (59% male, 88% white, median age at time of SOT of 54 years (IQR 40-62)). NTM infection occurred in kidney (42%), lung (35%), heart and liver (11% each), and pancreas transplant recipients (1%). Time from transplant to infection was 21.6 months (IQR 5.3-55.2). Most underlying comorbidities were evenly distributed between groups; however, cases were older at the time of NTM diagnosis, more frequently on systemic corticosteroids and had a lower lymphocyte count (all P < 0.05). In the multivariable model, older age at transplant (adjusted odds ratio [aOR] 1.04; 95 confidence interval [CI] 1.01-1.07), hospital admission within 90 days (aOR, 3.14; [1.41-6.98]), receipt of antifungals (aOR, 5.35; [1.7-16.91]), and lymphocyte-specific antibodies (aOR, 7.73, [1.07-56.14]), were associated with NTM infection. Conclusion Risk of NTM infection in SOT recipients was associated with older age at SOT, prior hospital admission, receipt of antifungals or lymphocyte-specific antibodies. NTM infection should be considered in SOT patients with these risk factors.

Bacterial infections in solid organ transplant recipients

“…A multinational retrospective study conducted with 85 cases and 169 controls aimed to identify risk factors for nontuberculous mycobacterial infections in SOT recipients [53]. Median time to infection was 21.6 months after transplantation with mainly pulmonary infections (58%).…”

Drugs for treating infections caused by non-tubercular mycobacteria: a narrative review from the study group on mycobacteria of the Italian Society of Infectious Diseases and Tropical Medicine

“…Although considered less virulent than Mycobacterium tuberculosis, NTM can cause infections that affect various organ systems, with the lungs, skin, soft tissues, and lymph nodes being the most frequently involved [15]. NTM diseases predominantly affect subjects with anatomic or structural airways/lungs abnormalities, such as bronchiectasis, chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF), or those with immune-deficiency condition, such as HIV infection, solid organ transplant, and cancer [16][17][18][19]. Additionally, increased incidence in individuals with other comorbidities, such as dyslipidemia, diabetes mellitus, asthma, and gastro-oesophageal reflux disease (GERD) has also been reported [16].…”