Lung Transplant Outcomes Following Treatment of Pre-Transplant MAC Pulmonary Infection

Treating Mycobacterium avium complex (MAC) infection pre-lung transplant (LT) can be challenging to treat, given prolonged therapy and side effects. The impact of pre-transplant MAC treatment on recurrence and outcomes post-LT remains unclear, especially in patients with interstitial lung disease (ILD) who have a median survival of less than 2 years.

We performed a retrospective cohort study of adult LT patients at the Mayo Clinic who had positive MAC sputum cultures pre-LT. The cohort was stratified and compared based on the type of treatment (complete, partial, or no treatment) for MAC pulmonary infection. The primary outcome was MAC recurrence post-LT, and secondary outcomes were mortality, FEV-1, and FVC at 1-year post-LT.

Among the cohort of 47 patients, 9 (19.1%) were partially treated and 11 (23.4%) were completely treated for MAC infection pre-LT. Post-transplant MAC pulmonary infection recurrence occurred in eight (17%) of the total cohort, with four (14.8%) in the non-treated, four (44.4%) in the partially-treated, and none (0%) in the completely treated patients (p = 0.026). There was no difference in mortality in patients who had MAC recurrence post-transplantation (13% vs. 9.7%, p > 0.9) and those who were completely or partially treated, compared to non-treated (0% vs. 13% vs. 13%, p > 0.9). The FEV1 and FVC at 1-year post-LT did not differ by the pre-transplant treatment or post-transplant MAC recurrence status.

The role of treatment for MAC infection pre-transplant is questionable, especially in patients with diseases like ILD who may not have enough wait time to complete therapy.