Risk factors and outcomes of non-tuberculous mycobacteria infection in lung transplant recipients: A systematic review and meta-analysis.

Background: Patients with structural lung disease and immunocompromised status are at increased risk of pulmonary non-tuberculous mycobacteria (NTM) infection. However, literature on NTM in lung transplant recipients (LTR) is limited. We sought to systematically review the literature and perform a meta-analysis to examine associations with NTM disease and isolation in LTRs and their influence on mortality and chronic lung allograft dysfunction (CLAD).
Methods: A literature search of MEDLINE and Embase was performed on February 23, 2022. NTM disease was defined according to international guidelines. Isolation was defined as any growth of NTM in culture. Odds ratios (OR) were pooled for risk factors of NTM disease or isolation, and hazard ratios (HR) were pooled for mortality or CLAD.
Results: Eleven studies totaling 3,371 patients were eligible for inclusion, 10 of which underwent meta-analysis. Cystic fibrosis (OR 1.84, 95% confidence interval [CI] 1.03-3.30; I ²  = 0%) and pre-transplant NTM isolation (OR 2.40, 95% CI 1.20-4.83; I ²  = 0%) were associated with NTM disease. Only male sex was associated with NTM isolation (OR 1.45, 95% CI 1.01-2.10; I ²  = 0%). NTM disease was associated with increased mortality (HR 2.69, 95% CI 1.70-4.26; I ²  = 0%) and CLAD (HR 2.11, 95% CI 1.03-4.35; I ²  = 44%). NTM isolation was not associated with mortality in pooled analysis or CLAD in 1 included study.
Conclusions: NTM disease, but not isolation, is associated with worse outcomes. Several factors were associated with development of NTM disease, including cystic fibrosis and pretransplant NTM isolation. Strategies to optimize prevention and treatment of NTM disease in lung transplant recipients are needed.
Competing Interests: Disclosure statement No funding was utilized in the preparation of this manuscript. P.E. and our institution have filed 2 patent applications related to immunodiagnostic laboratory methodologies for latent tuberculosis infection (Patent numbers: 9678071 and 10401360). To date, there has been no income or royalties associated with those filed patent applications. P.E. participated in a short-term advisory scientific board for DiaSorin Molecular in 2020, which was outside the scope of the submitted manuscript, and honorarium was paid to his institution. P.E. has been supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health [AI141591]. All other authors have no conflicts of interest to report.
(Copyright © 2022 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)