Purpose

Nontuberculous mycobacteria (NTM) infection is an important issue after lung transplantation. However, a large-scale epidemiological study on this issue in Korea is lacking. We aimed to evaluate the epidemiology of NTM infection after lung transplant surgery in Korea.

Methods

Between October 2012 and December 2018, we retrospectively evaluated lung transplant recipients in a referral hospital in South Korea. A total of 215 recipients were enrolled. The median age at transplantation was 56 years (range, 17–75), and 62% were men. Bronchoscopy was performed according to the surveillance protocol and clinical indications. A diagnosis of NTM infection was defined as a positive NTM culture from a bronchial washing, bronchoalveolar lavage sample, or two separate sputum samples. We determined NTM pulmonary disease (NTM-PD) according to the American Thoracic Society/Infectious Disease Society of America 2007 guidelines. The Kaplan–Meier method and log-rank test were used for conditional survival analysis in patients with follow-up of ≥12 months.

Results

Fourteen patients (6.5%) were diagnosed with NTM infection at a median of 11.8 months (range, 0.3–51.4) after transplantation. Nine patients (4.2%) were diagnosed with NTM-PD, and the incidence rate was 1980/100,000 person-years. Mycobacterium abscessus was the most common species causing NTM-PD (66%), followed by M. avium complex (33%). The presence of NTM infection did not influence all-cause mortality among those who underwent follow-up for ≥12 months (N = 133, log-rank P = 0.816).

Conclusion

The incidence of NTM-PD was considerably high among lung-transplant recipients. M. abscessus was the most common causative species of NTM-PD after lung transplantation.

中文翻译：

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肺移植后非结核分枝杆菌感染：韩国的单中心经验

目的

非结核分枝杆菌 (NTM) 感染是肺移植后的一个重要问题。然而，韩国缺乏对这一问题的大规模流行病学研究。我们旨在评估韩国肺移植手术后 NTM 感染的流行病学。

方法

在 2012 年 10 月至 2018 年 12 月期间，我们对韩国一家转诊医院的肺移植受者进行了回顾性评估。共有 215 名受助人参加。移植时的中位年龄为 56 岁（范围为 17-75 岁），其中 62% 为男性。根据监测方案和临床适应症进行支气管镜检查。NTM 感染的诊断定义为来自支气管冲洗液、支气管肺泡灌洗液样本或两个单独的痰液样本的 NTM 培养阳性。我们根据美国胸科学会/美国传染病学会 2007 年指南确定了 NTM 肺病 (NTM-PD)。Kaplan-Meier方法和时序检验用于随访≥12个月患者的条件生存分析。

结果

14 名患者 (6.5%) 在移植后的中位时间为 11.8 个月（范围 0.3-51.4）时被诊断为 NTM 感染。9例患者（4.2%）被诊断为NTM-PD，发病率为1980/100,000人年。脓肿分枝杆菌是导致 NTM-PD 的最常见物种（66%），其次是鸟分枝杆菌复合体（33%）。NTM 感染的存在不影响接受 ≥ 12 个月随访的患者的全因死亡率（N  = 133，对数秩P  = 0.816）。

结论

肺移植受者中 NTM-PD 的发生率相当高。脓肿分枝杆菌是肺移植后最常见的 NTM-PD 病原体。