Early pulmonary isolation of non-tuberculous mycobacterial organisms is associated with increased risk of death and chronic lung allograft dysfunction: A Lung Transplant Outcomes Group Cohort Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: How pulmonary non-tuberculous mycobacteria (NTM) impact lung transplant outcomes is unknown. We evaluated the effect of pulmonary isolation of NTM on death or re-transplantation and chronic lung allograft dysfunction (CLAD). METHODS: We performed a multicenter cohort study of adult lung transplant recipients at five US centers from 2007 to 2022. Our exposure was growth of NTM from pulmonary samples in the first year post-transplant ("early") in primary analyses, and growth at any time post-transplant in secondary analyses. We evaluated time from transplantation to death or re-transplantation and CLAD using separate covariate-adjusted proportional hazards models, each with a time-dependent exposure indicator for early first pulmonary NTM isolation. RESULTS: Of 1,766 lung transplant recipients, 223 (13%) had early pulmonary NTM isolation. NTM was first isolated at a median [interquartile range] of 61 [17-158] days after transplantation. Early NTM growth was associated with increased risk of death or re-transplantation (HR 1.30, 95% CI 1.05-1.60), driven by rapid growing NTM (HR 2.17, 95% CI 1.42-3.31). Early growth of NTM was associated with increased risk of CLAD (HR 1.29, 95% CI 1.03-1.62); this association was driven by slow growing NTM (HR 1.33, 95% CI 1.04-1.69). Association appeared modified by acute cellular rejection (p = 0.10) and pre-operative diagnosis (p = 0.04), with a stronger association in recipients with ILD (HR 1.67, 95% CI 1.26-2.20). Similar associations were present for NTM growth at any time post-transplant. CONCLUSIONS: Pulmonary growth of NTM in the first post-transplant year occurred frequently and was associated with increased risk of death or re-transplantation and CLAD.
Authors: Gabrielle Mezochow, Stephen Griffiths, Douglas E. Schaubel, Michelle Oyster, Laurel Kalman, Alyssa Mezochow, Emily Blumberg, Gina Hong, Denis Hadjiliadis, Krishna Pandya, Tamara Claridge, Stephanie Witek, Luke Benvenuto, Dennis Lyu, Michael P. Combs, Pali Shah, Christian Merlo, Aida Venado Estrada, Jonathan P. Singer, Scott Palmer, Jason D. Christie, Michaela R. Anderson
Institutions: University of Pennsylvania, Hospital of the University of Pennsylvania, Columbia University Irving Medical Center, Columbia University, University of Michigan, Michigan Medicine, Vanderbilt University, Vanderbilt University Medical Center, Johns Hopkins University, Johns Hopkins Medicine, Johns Hopkins Hospital, University of California, San Francisco, University of California San Francisco Medical Center, Duke Medical Center
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,606
OpenAlex ID: W7204813629