The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026
Early pulmonary isolation of non-tuberculous mycobacterial organisms is associated with increased risk of death and chronic lung allograft dysfunction: A Lung Transplant Outcomes Group Cohort Study.
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Mezochow Gabrielle, Griffiths Stephen, Schaubel Douglas E, Oyster Michelle, Kalman Laurel, Mezochow Alyssa, Blumberg Emily, Hong Gina, Hadjiliadis Denis, Pandya Krishna, Claridge Tamara, Witek Stephanie, Benvenuto Luke, Lyu Dennis, Combs Michael P, Shah Pali, Merlo Christian, Estrada Aida Venado, Singer Jonathan P, Palmer Scott, Christie Jason D, Anderson Michaela R
Аннотация
BACKGROUND: How pulmonary non-tuberculous mycobacteria (NTM) impact lung transplant outcomes is unknown. We evaluated the effect of pulmonary isolation of NTM on death or re-transplantation and chronic lung allograft dysfunction (CLAD).
METHODS: We performed a multicenter cohort study of adult lung transplant recipients at five US centers from 2007 to 2022. Our exposure was growth of NTM from pulmonary samples in the first year post-transplant ("early") in primary analyses, and growth at any time post-transplant in secondary analyses. We evaluated time from transplantation to death or re-transplantation and CLAD using separate covariate-adjusted proportional hazards models, each with a time-dependent exposure indicator for early first pulmonary NTM isolation.
RESULTS: Of 1,766 lung transplant recipients, 223 (13%) had early pulmonary NTM isolation. NTM was first isolated at a median [interquartile range] of 61 [17-158] days after transplantation. Early NTM growth was associated with increased risk of death or re-transplantation (HR 1.30, 95% CI 1.05-1.60), driven by rapid growing NTM (HR 2.17, 95% CI 1.42-3.31). Early growth of NTM was associated with increased risk of CLAD (HR 1.29, 95% CI 1.03-1.62); this association was driven by slow growing NTM (HR 1.33, 95% CI 1.04-1.69). Association appeared modified by acute cellular rejection (p = 0.10) and pre-operative diagnosis (p = 0.04), with a stronger association in recipients with ILD (HR 1.67, 95% CI 1.26-2.20). Similar associations were present for NTM growth at any time post-transplant.
CONCLUSIONS: Pulmonary growth of NTM in the first post-transplant year occurred frequently and was associated with increased risk of death or re-transplantation and CLAD.
METHODS: We performed a multicenter cohort study of adult lung transplant recipients at five US centers from 2007 to 2022. Our exposure was growth of NTM from pulmonary samples in the first year post-transplant ("early") in primary analyses, and growth at any time post-transplant in secondary analyses. We evaluated time from transplantation to death or re-transplantation and CLAD using separate covariate-adjusted proportional hazards models, each with a time-dependent exposure indicator for early first pulmonary NTM isolation.
RESULTS: Of 1,766 lung transplant recipients, 223 (13%) had early pulmonary NTM isolation. NTM was first isolated at a median [interquartile range] of 61 [17-158] days after transplantation. Early NTM growth was associated with increased risk of death or re-transplantation (HR 1.30, 95% CI 1.05-1.60), driven by rapid growing NTM (HR 2.17, 95% CI 1.42-3.31). Early growth of NTM was associated with increased risk of CLAD (HR 1.29, 95% CI 1.03-1.62); this association was driven by slow growing NTM (HR 1.33, 95% CI 1.04-1.69). Association appeared modified by acute cellular rejection (p = 0.10) and pre-operative diagnosis (p = 0.04), with a stronger association in recipients with ILD (HR 1.67, 95% CI 1.26-2.20). Similar associations were present for NTM growth at any time post-transplant.
CONCLUSIONS: Pulmonary growth of NTM in the first post-transplant year occurred frequently and was associated with increased risk of death or re-transplantation and CLAD.