Few reports exist regarding prevalence and morbidity of mycobacterial disease in solid organ recipients (SOR). We describe the mycobacterial isolates from 1995 to 2003 in all SORs from our institution.
A review of all mycobacterial cultures from 1995-2003 was done. The prevalence was determined among the individual kidney, heart, liver, and lung transplant recipients from the database. A case was defined as a patient with at least one isolate of a single mycobacterial species from any source in one year. Patients with the same organism isolated repeatedly in different nonconsecutive years were counted as new cases.
Of 781 mycobacterial isolates, 691 cases were found of which 62(7.9%) isolates were identified in 51 (7.4%) of the SOR. The majority of the cases in the SOR (78%) had isolates cultured from the respiratory tract (n= 40). All cases in lung recipients were identified from the airways or pleural space. The following mycobacterial species were isolated: M avium (n=23), M abscessus (n=14), M chelonei (n=7), M gordonae (n=2), and M kansasii (n=2) with one case of M xenopi, and M marinum. The only case of infection due to Mycobacteria tuberculosis occurred in a kidney recipient, seven years after living-related transplantation. While M avium was the most common species isolated (45%) in SOR, half of the M abscessus cases were seen in the lung transplant recipients in 2002 and 2003. The tableProportion of all institutional casesDistribution in Solid Organ RecipientsCases/Solid Organ RecipientsLiver (n= 675)0.8%12%0.9% (n= 6)Heart (n= 634)2.3%31%2.5% (n= 16)Cadaveric Kidney (n= 666)0.9%12%0.9% (n= 6)Living Related Kidney (n= 264)0.4%6%1.1% (n= 3)Lung (n= 192)2.9%39%10.4% (n= 20)below represents the proportions of cases according to the transplanted organ.
While mycobacterial infection continues to be an uncommon complication in organ transplantation, up to 7.9% of cases in a transplant center originate from organ recipients. The highest proportion of mycobacterial isolates (10.4%) is recovered from the lung recipients which is nearly 10 times greater than kidney or liver recipients.
M abscessus is becoming a more common pathogen in lung recipients than previously reported and may represent a future threat to lung transplantation.
F.G. Jamous, None.