RT Journal Article
SR Electronic
T1 Management of nontuberculous mycobacteria in lung transplant cases: an international Delphi study
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00377-2022
DO 10.1183/23120541.00377-2022
VO 9
IS 2
A1 Huda Asif
A1 Franck F. Rahaghi
A1 Akihiro Ohsumi
A1 Julie Philley
A1 Amir Emtiazjoo
A1 Takashi Hirama
A1 Arthur W. Baker
A1 Chin-Chung Shu
A1 Fernanda Silveira
A1 Vincent Poulin
A1 Pete Rizzuto
A1 Miki Nagao
A1 Pierre-Régis Burgel
A1 Steve Hays
A1 Timothy Aksamit
A1 Takeshi Kawasaki
A1 Charles Dela Cruz
A1 Stefano Aliberti
A1 Takahiro Nakajima
A1 Stephen Ruoss
A1 Theodore K. Marras
A1 Gregory I. Snell
A1 Kevin Winthrop
A1 Mehdi Mirsaeidi
YR 2023
UL http://openres.ersjournals.com/content/9/2/00377-2022.abstract
AB Rationale Nontuberculous mycobacterial (NTM) diseases are difficult-to-treat infections, especially in lung transplant (LTx) candidates. Currently, there is a paucity of recommendations on the management of NTM infections in LTx, focusing on Mycobacterium avium complex (MAC), M. abscessus and M. kansasii.Methods Pulmonologists, infectious disease specialists, LTx surgeons and Delphi experts with expertise in NTM were recruited. A patient representative was also invited. Three questionnaires comprising questions with multiple response statements were distributed to panellists. Delphi methodology with a Likert scale of 11 points (5 to −5) was applied to define the agreement between experts. Responses from the first two questionnaires were collated to develop a final questionnaire. The consensus was described as a median rating >4 or <−4 indicating for or against the given statement. After the last round of questionnaires, a cumulative report was generated.Results Panellists recommend performing sputum cultures and a chest computed tomography scan for NTM screening in LTx candidates. Panellists recommend against absolute contraindication to LTx even with multiple positive sputum cultures for MAC, M. abscessus or M. kansasii. Panellists recommend MAC patients on antimicrobial treatment and culture negative can be listed for LTx without further delay. Panellists recommend 6 months of culture-negative for M. kansasii, but 12 months of further treatment from the time of culture-negative for M. abscessus before listing for LTx.Conclusion This NTM LTx study consensus statement provides essential recommendations for NTM management in LTx and can be utilised as an expert opinion while awaiting evidence-based contributions.Experts recommend performing sputum cultures and a chest CT scan for NTM screening in lung transplant candidates. They recommend against absolute contraindication to lung transplantation even with multiple positive sputum cultures for NTM. https://bit.ly/3WaSwLe