title: Non-tuberculous mycobacterium infection after lung transplantation is associated with increased mortality.
abstract: BACKGROUND
  Pulmonary non-tuberculous mycobacterial (NTM) infection is relatively common after lung transplantation, but the effect on mortality remains undetermined. Herein we describe our experience with pulmonary NTM infection after lung transplantation and hypothesized that non-tuberculous mycobacterial infection after lung transplantation would be associated with increased mortality.
  
  
  METHODS
  We retrospectively evaluated 201 primary lung transplant recipients transplanted between January 2000 and August 2006. Serial bronchoscopies with bronchoalveolar lavage and transbronchial biopsy were performed according to a surveillance protocol and when clinically indicated. The diagnosis NTM infection was established by a positive NTM culture in a bronchoalveolar lavage sample or in at least two separate expectorated sputum samples. NTM infections were further classified as "disease" or "colonization," based on whether or not NTM infection patients developed symptoms and characteristic radiographic findings.
  
  
  RESULTS
  Thirty-six (18%) recipients were diagnosed with pulmonary NTM infection at a median of 97 days post-transplantation: 9 were classified as NTM disease and the remaining 27 as NTM colonization cases. Single lung transplant was a significant risk factor for NTM infection (HR 2.25, p = 0.02). NTM colonization was a risk factor for NTM disease (HR 8.39, p = 0.003). NTM infection significantly increased the risk of death after lung transplantation (HR 2.61, p = 0.001) and persisted in multivariate models controlling for single lung transplant and bronchiolitis obliterans syndrome. The increased risk was seen for both NTM colonization and NTM disease. Among the patients who died, non-NTM infection was a more common contributing factor in the cause of death for the NTM infection group (44% vs 12%, p = 0.04).
  
  
  CONCLUSIONS
  Non-tuberculous mycobacterial infection is common after lung transplantation. NTM colonization and treated acute rejection are risk factors for NTM disease. NTM infection is associated with increased risk of mortality independent of bronchiolitis obliterans syndrome.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095-1690, USA.
authors.forename: Hsuanwen C
authors.initials: HC
authors.lastname: Huang
authors.forename: S Samuel
authors.initials: SS
authors.lastname: Weigt
authors.forename: Ariss
authors.initials: A
authors.lastname: Derhovanessian
authors.forename: Vyacheslav
authors.initials: V
authors.lastname: Palchevskiy
authors.forename: Abbas
authors.initials: A
authors.lastname: Ardehali
authors.forename: Rajan
authors.initials: R
authors.lastname: Saggar
authors.forename: Rajeev
authors.initials: R
authors.lastname: Saggar
authors.forename: Bernard
authors.initials: B
authors.lastname: Kubak
authors.forename: Aric
authors.initials: A
authors.lastname: Gregson
authors.forename: David J
authors.initials: DJ
authors.lastname: Ross
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Lynch
authors.forename: Robert
authors.initials: R
authors.lastname: Elashoff
authors.forename: John A
authors.initials: JA
authors.lastname: Belperio
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000382:microbiology* / Q000401:mortality; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000382:microbiology* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors