Clinical Management and Outcomes of Nontuberculous Mycobacterial Infections in Solid Organ Transplant Recipients: A Multinational Case-control Study.
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
25 Jul 2024
25 Jul 2024
Historique:
medline:
26
7
2024
pubmed:
26
7
2024
entrez:
25
7
2024
Statut:
aheadofprint
Résumé
The management and outcomes of nontuberculous mycobacterial (NTM) infections in solid organ transplant (SOT) recipients are poorly characterized. We aimed to describe the management and 1-y mortality of these patients. Retrospective, multinational, 1:2 matched case-control study included SOT recipients aged 12 y old or older diagnosed with NTM infection between January 1, 2008, and December 31, 2018. Controls were matched on transplanted organs, NTM treatment center, and posttransplant survival at least equal to the time to NTM diagnosis. The primary aim was 1-y mortality after NTM diagnosis. Differences between cases and controls were compared using the log-rank test, and Cox regression models were used to identify factors associated with mortality at 12 mo among cases. In 85 patients and 169 controls, the median age at the time of SOT was 54 y (interquartile range, 40-62 y), 59% were men, and the lungs were the most common site of infection after SOT (57.6%). One-year mortality was significantly higher in cases than in controls (20% versus 3%; P < 0.001), and higher mortality was associated with lung transplantation (hazard ratio 3.27; 95% confidence interval [1.1-9.77]; P = 0.034). Median time (interquartile range) from diagnosis to treatment initiation (20 [4-42] versus 11 [3-21] d) or the reduction of net immunosuppression (36% versus 45%, hazard ratio 1.35 [95% CI, 0.41-4.43], P = 0.618) did not differ between survivors and those who died. NTM disease in SOT recipients is associated with a higher mortality risk, especially among lung transplant recipients. Time to NTM treatment and reduction in net immunosuppression were not associated with mortality.
Sections du résumé
BACKGROUND
BACKGROUND
The management and outcomes of nontuberculous mycobacterial (NTM) infections in solid organ transplant (SOT) recipients are poorly characterized. We aimed to describe the management and 1-y mortality of these patients.
METHODS
METHODS
Retrospective, multinational, 1:2 matched case-control study included SOT recipients aged 12 y old or older diagnosed with NTM infection between January 1, 2008, and December 31, 2018. Controls were matched on transplanted organs, NTM treatment center, and posttransplant survival at least equal to the time to NTM diagnosis. The primary aim was 1-y mortality after NTM diagnosis. Differences between cases and controls were compared using the log-rank test, and Cox regression models were used to identify factors associated with mortality at 12 mo among cases.
RESULTS
RESULTS
In 85 patients and 169 controls, the median age at the time of SOT was 54 y (interquartile range, 40-62 y), 59% were men, and the lungs were the most common site of infection after SOT (57.6%). One-year mortality was significantly higher in cases than in controls (20% versus 3%; P < 0.001), and higher mortality was associated with lung transplantation (hazard ratio 3.27; 95% confidence interval [1.1-9.77]; P = 0.034). Median time (interquartile range) from diagnosis to treatment initiation (20 [4-42] versus 11 [3-21] d) or the reduction of net immunosuppression (36% versus 45%, hazard ratio 1.35 [95% CI, 0.41-4.43], P = 0.618) did not differ between survivors and those who died.
CONCLUSIONS
CONCLUSIONS
NTM disease in SOT recipients is associated with a higher mortality risk, especially among lung transplant recipients. Time to NTM treatment and reduction in net immunosuppression were not associated with mortality.
Identifiants
pubmed: 39049076
doi: 10.1097/TP.0000000000005156
pii: 00007890-990000000-00830
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : none
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no funding or conflicts of interest.
Références
Fernandez-Ruiz M, Lopez-Medrano F, Aguado JM. Predictive tools to determine risk of infection in kidney transplant recipients. Expert Rev Anti Infect Ther. 2020;18:423–441.
Ojo AO, Morales JM, Gonzalez-Molina M, et al.; Scientific Registry of Transplant Recipients, and Spanish Chronic Allograft Study Group. Comparison of the long-term outcomes of kidney transplantation: USA versus Spain. Nephrol Dial Transplant. 2013;28:213–220.
Hernandez D, Moreso F. Has patient survival following renal transplantation improved in the era of modern immunosuppression? Nefrologia. 2013;33:171–180.
Pennington KM, Vu A, Challener D, et al. Approach to the diagnosis and treatment of non-tuberculous mycobacterial disease. J Clin Tuberc Other Mycobact Dis. 2021;24:100244.
Daley CL, Iaccarino JM, Lange C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: An Official ATS/ERS/ESCMID/IDSA clinical practice guideline. Clin Infect Dis. 2020;71:905–913.
Dahl VN, Molhave M, Floe A, et al. Global trends of pulmonary infections with nontuberculous Mycobacteria: a systematic review. Int J Infect Dis. 2022;125:120–131.
Winthrop KL, Marras TK, Adjemian J, et al. Incidence and prevalence of nontuberculous mycobacterial lung disease in a large U.S. managed care health plan, 2008-2015. Ann Am Thorac Soc. 2020;17:178–185.
Ratnatunga CN, Lutzky VP, Kupz A, et al. The rise of non-tuberculosis mycobacterial lung disease. Front Immunol. 2020;11:303.
Kim JY, Han A, Lee H, et al. The clinical course and prognosis of patients with nontuberculous mycobacterial pulmonary disease after solid organ transplantation. J Korean Med Sci. 2023;38:e46.
Masalmani MA, Hashim SMA, Ittaman A, et al. Case series of rapidly growing mycobacterial post-operative surgical site infection in kidney transplant recipients. IDCases. 2022;30:e01640.
Mejia-Chew C, Carver PL, Rutjanawech S, et al. Risk factors for nontuberculous Mycobacteria infections in solid organ transplant recipients: a multinational case-control study. Clin Infect Dis. 2023;76:e995–e1003.
Shah SK, McAnally KJ, Seoane L, et al. Analysis of pulmonary non-tuberculous mycobacterial infections after lung transplantation. Transpl Infect Dis. 2016;18:585–591.
Knoll BM, Kappagoda S, Gill RR, et al. Non-tuberculous mycobacterial infection among lung transplant recipients: a 15-year cohort study. Transpl Infect Dis. 2012;14:452–460.
Longworth SA, Vinnard C, Lee I, et al. Risk factors for nontuberculous mycobacterial infections in solid organ transplant recipients: a case-control study. Transpl Infect Dis. 2014;16:76–83.
Friedman DZP, Cervera C, Halloran K, et al. Non-tuberculous Mycobacteria in lung transplant recipients: prevalence, risk factors, and impact on survival and chronic lung allograft dysfunction. Transpl Infect Dis. 2020;22:e13229.
Huang HC, Weigt SS, Derhovanessian A, et al. Non-tuberculous mycobacterium infection after lung transplantation is associated with increased mortality. J Heart Lung Transplant. 2011;30:790–798.
Osmani M, Sotello D, Alvarez S, et al. Mycobacterium abscessus infections in lung transplant recipients: 15-year experience from a single institution. Transpl Infect Dis. 2018;20:e12835.
George IA, Santos CA, Olsen MA, et al. Epidemiology and outcomes of nontuberculous mycobacterial infections in solid organ transplant recipients at a midwestern center. Transplantation. 2016;100:1073–1078.
Marty PK, Yetmar ZA, Gerberi DJ, et al. Risk factors and outcomes of non-tuberculous Mycobacteria infection in lung transplant recipients: a systematic review and meta-analysis. J Heart Lung Transplant. 2023;42:264–274.
Grimes R, Cherrier L, Nasar A, et al. Outcomes of nontuberculous Mycobacteria isolation among lung transplant recipients: a matched case-control with retrospective cohort study. Am J Health Syst Pharm. 2022;79:338–345.
Longworth SA, Daly JS; AST Infectious Diseases Community of Practice. Management of infections due to nontuberculous Mycobacteria in solid organ transplant recipients—guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33:e13588.
Longworth SA, Blumberg EA, Barton TD, et al. Non-tuberculous mycobacterial infections after solid organ transplantation: a survival analysis. Clin Microbiol Infect. 2015;21:43–47.
Friedman DZP, Carlos Cervera C, Halloran K. Non-tuberculous Mycobacteria in lung transplant recipients: prevalence, risk factors, and impact on survival and chronic lung allograft dysfunction. Transpl Infect Dis. 2020;22:e13229.
Abad CL, Razonable RR. Non-tuberculous mycobacterial infections in solid organ transplant recipients: an update. J Clin Tuberculosis Other Mycobacterial Dis. 2016;4:1–8.
Griffith DE, Aksamit T, Brown-Elliott BA, et al.; ATS Mycobacterial Diseases Subcommittee. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367–416.
Haworth CS, Banks J, Capstick T, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017;72(Suppl 2):ii1–ii64.
Harris PA, Taylor R, Minor BL, et al.; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
Woods GL, Brown-Elliott BA, Conville PS, et al. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes. 2nd ed. Clinical and Laboratory Standards Institute; 2011.
Kim JY, Choi Y, Park J, et al. Impact of treatment on long-term survival of patients with Mycobacterium avium complex pulmonary disease. Clin Infect Dis. 2023;77:120–126.
Zweijpfenning S, Kops S, Magis-Escurra C, et al. Treatment and outcome of non-tuberculous mycobacterial pulmonary disease in a predominantly fibro-cavitary disease cohort. Respir Med. 2017;131:220–224.
Spec A, Mejia-Chew C, Powderly WG, et al. EQUAL Cryptococcus Score 2018: a European Confederation of Medical Mycology score derived from current guidelines to measure QUALity of clinical cryptococcosis management. Open Forum Infect Dis. 2018;5:ofy299.
Sprute R, Van Braeckel E, Flick H, et al. EQUAL CPA Score 2022: a tool to measure guideline adherence for chronic pulmonary aspergillosis. J Antimicrob Chemother. 2022;78:225–231.
Ku JH, Henkle E, Aksamit TR, et al.; Bronchiectasis and NTM Research Registry Investigators. Treatment of nontuberculous mycobacterial (NTM) pulmonary infection in the US bronchiectasis and NTM Registry: treatment patterns, adverse events, and adherence to American Thoracic Society/Infectious Disease Society of America Treatment Guidelines. Clin Infect Dis. 2023;76:338–341.
Roberts MB, Fishman JA. Immunosuppressive agents and infectious risk in transplantation: managing the “net state of immunosuppression”. Clin Infect Dis. 2021;73:e1302–e1317.
Dedrick RM, Smith BE, Cristinziano M, et al. Phage therapy of mycobacterium infections: compassionate use of phages in 20 patients with drug-resistant mycobacterial disease. Clin Infect Dis. 2023;76:103–112.
Seidel D, Duran Graeff LA, Vehreschild M, et al. FungiScopeTM—Global Emerging Fungal Infection Registry. Mycoses. 2017;60:508–516.