Chest
Volume 115, Issue 3, March 1999, Pages 741-745
Journal home page for Chest

Clinical Investigations
Infection
Mycobacterial Infections in Lung Transplant Recipients

https://doi.org/10.1378/chest.115.3.741Get rights and content

Background

Immunosuppression and chronic lung disease are known risk factors for mycobacterial infection and might be expected to develop with an increased frequency in lung transplant recipients. We therefore sought to document the incidence and type of mycobacterial infections in a large lung transplant program.

Methods

A retrospective review of 219 transplant procedures (60 single lung transplants and 159 double lung transplants) in 210 patients was conducted. All patients had scheduled surveillance bronchoscopies at 3, 6, 9, 12, 18, and 24 months, and yearly thereafter. BAL samples were processed routinely for mycobacterium.

Results

Eight patients (3.8%) had evidence of infection (5 men, 3 women; age range, 26 to 63 years). The reasons for transplant were obstructive lung disease (six), cystic fibrosis (one), and pulmonary fibrosis (one). Five recipients had infection in their native lungs; two of five cultured mycobacterium from BAL following transplantation. At least four of five patients had nontuberculous mycobacterium (one showed acid fast bacilli and granuloma on a biopsy specimen that was not sent for culture). None of the five developed disease (mean follow-up = 22 months; range, 3 to 30 months). The organisms were Mycobacterium avium complex (three), Mycobacterium xenopi (one), and unidentified (one). Of the three remaining patients who developed infection after transplantation, one grew Mycobacterium chelonae and the others grew Mycobacterium tuberculosis (both received double lung transplants and had no evidence of mycobacterium in their native lungs). The only definite symptomatic disease occurred in the patients with M tuberculosis, one of whom had evidence of dissemination. The patients with M tuberculosis responded to standard treatment. There have been no deaths due to mycobacterium.

Conclusion

Mycobacterial disease rarely occurs following lung transplantation. Cultures for mycobacterium in surveillance BALs in the absence of symptoms are likely unnecessary.

Section snippets

Study Design

A retrospective review of medical records was conducted for all lung transplant recipients who had transplants between November 1983 and February 1996. Subjects who had positive cultures for mycobacterium or staining positive for acid-fast bacilli were included. The following information was recorded: isolation and identification of organism before and after transplantation, clinical manifestations of disease following transplantation, treatment prescribed, response to treatment, and outcomes

Patient Population

The records of 210 recipients (210 first transplants and 9 retransplant procedures) were reviewed. There were 159 double lung transplants and 60 single lung transplants. There were eight patients with evidence of mycobacterial infection (3.8%), all of whom received a double lung transplant. Of the eight patients, five were men and three were women. The age range was between 26 and 63 years. The reasons for transplantation were obstructive lung disease (six), cystic fibrosis (one), and pulmonary

Discussion

Mycobacterial infections have been reported in patients with organ transplants, chronic lung disease, and in patients with AIDS. Immunosuppression increases the risk for mycobacterial infection.1,2,3,6,7 We have reported our experience with mycobacterium in 219 transplant procedures. In our series, mycobacterium has been documented in only 3.8% of cases. Two of the patients in our series had indolent disease without extrathoracic signs or symptoms and responded well to treatment. No changes in

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