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Updated: Jun 15, 2025
Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
Clinical outcomes of lung transplant recipients with pre-transplant Mycobacterium avium complex infection
Sonya M Kothadia1, Eric E Cober1, Christine E Koval1
1Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Lung transplant recipients (LTRs) are at risk for Mycobacterium avium complex (MAC) infections, in part due to the presence of structural lung disease pre-transplant and relatively higher levels of immunosuppression post-transplant. There is a lack of data regarding outcomes of LTR with MAC infections pre-transplant.
Methods:
This is a single-center retrospective analysis of patients who received lung transplants (LTs) from 2013 to 2020 with 1) evidence of MAC on culture or polymerase chain reaction before or at the time of transplant or 2) granulomas on explant pathology and positive acid-fast bacillus stains with no other mycobacteria identified. Patients were deemed to have MAC pulmonary disease (MAC-PD) if they met the American Thoracic Society/Infectious Disease Society of America criteria.
Results:
Fourteen patients (14/882, 2%) met inclusion criteria. Seven patients (7/14, 50%) had pre-transplant MAC-PD, four of whom had cavitary disease. None of the 14 patients had smear-positive cultures at the time of transplant. Two patients in our cohort received treatment for MAC before transplant. Thirteen patients were bilateral LTR (13/14, 93%). One single LTR was the sole patient to receive MAC treatment post-transplant. No patients developed MAC-PD after transplant.
Conclusion:
The bilateral LTR in our cohort did not develop MAC-PD despite not receiving MAC treatment post-transplant. It is possible source control was achieved with native lung explantation. Our observations suggest patients may not uniformly require pre- or post-transplant MAC treatment if they are smear-negative and undergo bilateral LT.
Insights
Lung transplant recipients with pre-existing Mycobacterium avium complex (MAC) pulmonary disease (MAC-PD) may not require post-transplant MAC treatment, especially after bilateral lung transplantation. Bilateral lung transplant recipients in this study did not develop MAC-PD post-transplant.
Area of Science:
- Pulmonology
- Infectious Diseases
- Transplantation Immunology
Background:
- Lung transplant recipients (LTRs) face increased risk of Mycobacterium avium complex (MAC) infections due to pre-existing lung conditions and immunosuppression.
- Limited data exists on outcomes for LTRs with MAC infections diagnosed before lung transplantation.
Purpose of the Study:
- To investigate the outcomes of lung transplant recipients with pre-transplant Mycobacterium avium complex (MAC) infections.
- To assess the necessity of pre- and post-transplant MAC treatment in this patient population.
Main Methods:
- Retrospective analysis of lung transplant recipients (2013-2020) with evidence of MAC infection pre-transplant or on explant pathology.
- Patients were diagnosed with MAC pulmonary disease (MAC-PD) based on established clinical criteria.
Main Results:
- 14 out of 882 (2%) LTRs met inclusion criteria for pre-transplant MAC.
- Seven patients (50%) had pre-transplant MAC-PD, with four exhibiting cavitary disease.
- No patients developed MAC-PD post-transplant; 93% of included patients underwent bilateral lung transplantation.
Conclusions:
- Bilateral lung transplant recipients with pre-transplant MAC did not develop post-transplant MAC-PD, even without specific MAC treatment.
- Native lung explantation may provide sufficient source control.
- Smear-negative patients undergoing bilateral lung transplantation might not require uniform pre- or post-transplant MAC treatment.
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