The spectrum of mycobacterial infection after lung transplantation

Despite the success of lung transplantation, infection is one of the leadin g causes of morbidity and mortality. Mycobacterial infections have been rep orted rarely, with the majority due to Mycobacterium tuberculosis. Our aim was to assess the incidence, etiology, and clinical outcome of mycobacteria l infection after lung transplantation; to do so, we have studied retrospec tively all lung and heart-lung transplants performed over a 12-yr period be tween November 1986 and lune 1998 (n = 261). Twenty-three patients (9%) (M: F, 11:12) were diagnosed with mycobacterial infections in 25 sites, includi ng n = 19, pulmonary (M. avium complex [n = 13], M. tuberculosis [n = 2], M . abscessus [n = 2], M. asiaticum [n = 1], and M. kansasii [n = 1]) and n = 6 extrapulmonary (M. haemophilum [n = 5] and M. obscessus [n = 1]) infecti ons. Time to diagnosis from transplantation was 677 +/- 735 d (range, 2-3,0 86 d). Three episodes of transient colonization with M. avium were not trea ted; the remaining (22 of 25, 88%) were treated. Initial baseline therapy f or nontuberculous mycobacteria included clarithromycin, rifampicin, ciprofl oxacin, and/or ethambutol. All cutaneous lesions resolved completely, while clinical and graft function improved in 11 of 16 (69%) and 8 of 16 (50%) o f patients treated, respectively. Seventeen of 23 patients (72%) survived a t a follow-up of 1,658 +/- 759 d (range, 522-3,285 d). Complications, predo minantly due to rifampicin, included gastrointestinal intolerance and an in creased tendency for rejection. There were no deaths attributable to mycoba cterial disease or therapy. We conclude that mycobacterial infection, parti cularly due to nontuberculous mycobacteria, is relatively common after lung transplantation and may be an unrecognized cause of graft dysfunction. Ear ly treatment of cutaneous lesions is associated with excellent control; how ever, graft dysfunction may be permanent. Although drug toxicity and intera ctions with immunosuppressive agents were not infrequent, the majority of t hese infections can be managed successfully.