Most rapidly growing nontuberculous mycobacterial infections are due to Mycobacterium abscessus. Isolated reports of M. abscessus infection after lung transplantation (LT) suggest this species poses a significant threat to lung allograft recipients(LARs). We report our experiences and clinical outcomes of M. abscessus infection following LT.
We performed a retrospective chart review of 197 LARs performed at our institution between 1991 and 2005. Infection was defined as symptoms in the prescence of chest radiograph changes and positive cultures from a bronchoalveolar lavage (BAL).
Eight (4%) LARs were diagnosed with M. abscessus pulmonary infection. The transplant diagnosis included cystic fibrosis (3), emphysema (3), idiopathic pulmonary fibrosis (IPF)(1), and sarcoid (1). One LAR had M. abscessus prior to transplant and died because of disseminated infection peri-operatively. All underwent bilateral lung transplants except the LAR with IPF. The most common symptoms were dyspnea, cough, and fever. Two deaths may be directly attributable to M. abscessus, since both patients died of respiratory failure with granulomatous pnuemonia on autopsy. Five patients responded to therapy as demonstrated by improved symptoms and culture negativity on repeat BAL.
The prevalence of M. abscessus is relatively low post LT. Although it may be a potentially fatal pathogen in LARs, the majority of infected LARs respond to therapy. A multi-institutional study may further our understanding of M. abscessus infections among LARs.
M. absessus poses a significant threat to LARs. However, successful treatment of M. abscessus is possible post LT.
Leonardo Seoane, None.