The Clinical Course and Prognosis of Patients With Nontuberculous Mycobacterial Pulmonary Disease After Solid Organ Transplantation

Background: Due to impaired cell-mediated immunity, solid organ transplantation (SOT) recipients are at increased risk of developing nontuberculous mycobacterial pulmonary disease (NTM-PD).However, the clinical course of NTM-PD in SOT patients and the impact of SOT on the prognosis of NTM-PD remain unclear.Methods: We analyzed patients who developed NTM-PD after receiving SOT between January 2001 and December 2020, at a tertiary referral hospital in South Korea.Baseline characteristics, clinical course, and prognosis were evaluated.Propensity score-matched analysis was performed to assess the impact of SOT on long-term survival in patients with NTM-PD.Results: Among 4,685 SOT recipients over 20 years, 12 patients (median age, 64 years; interquartile range [IQR], 59-67 years; men, 66.7%) developed NTM-PD.Seven (58.3%) and five (41.7%) patients underwent kidney and liver transplantation, respectively, before the diagnosis of NTM-PD.The incidence of NTM-PD was 35.6 cases per 100,000 person-years among kidney transplant recipients and 28.7 cases per 100,000 person-years among liver transplant recipients.The median time between transplantation and the diagnosis of NTM-PD was 3.3 (IQR, 1.5-10.8)years.The most common mycobacterial species was Mycobacterium avium (50.0%).Antibiotic treatment was initiated in five (41.7%) patients, and two patients (40.0%) achieved microbiological cure.Two patients died during a median follow-up of 4.2 (IQR, 2.3-8.8)years and NTM-PD was assumed to be the cause of death in one patient.When matched to patients without a history of SOT, patients with a history of SOT did not show worse survival (P value for log-rank test = 0.62). Conclusion:The clinical course of NTM-PD in SOT recipients was comparable to that of patients without SOT, and SOT did not increase the risk of all-cause mortality in patients with NTM-PD.