1090. Mycobacterial Infections after Lung Transplantation: Risk Factors and Impact on Graft Survival and Mortality in the Era of Improved Detection
Session: Poster Abstract Session: Infections After Solid Organ Transplants
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • Katsolis_MBI_Poster.pdf (3.1 MB)
  • Background: 

    Mycobacterial infection (MBI) is a challenging and potentially life-threatening complication in lung transplant recipients (LTR).  Risk factors for the development of MBI after transplant, as well as the potential association with increased graft loss or death, have not been completely defined in this patient population. 

    Methods: 

    Between June 1, 2001 and June 30, 2009, 224 consecutive first LTs performed at Mayo Clinic Florida were retrospectively analyzed.  Use of anti-thymocyte globulin (ATG) for induction began in 2006 in our institution.  MBI was defined as at least 1 positive culture for mycobacteria from any body fluid or tissue identified by our Microbiology laboratory before, during, or after LT.  Mycobacterial disease (tuberculous and non-tuberculous) was defined by American Thoracic Society (ATS)/ Infectious Disease Society of America (IDSA) guidelines.  Patient, donor and operative characteristics, in addition to post-transplant potential risk factors for MBI occurring within the first transplant year were collected.  Potential risk factors and their association with MBI were assessed using multivariable Cox proportional hazards regression models.

    Results: 

    MBI was diagnosed in 45 LTR (20%); 12 (5%) were treated for mycobacterial disease.  Factors significantly associated with increased risk of MBI were cystic fibrosis (Relative Risk [RR]: 2.83, P=0.029), ATG induction (RR: 2.02, P=0.038), no acute rejection within year 1 (AR-yr1) [RR {rejection vs. no rejection}: 0.41, P=0.045) and transplant hospitalization longer than 30 days (RR: 2.57, P=0.044).  MBI was strongly associated with increased risk of graft loss (RR: 2.87, P<0.001) and was also associated with increased risk of death (RR: 1.92, P=0.040). 

    Conclusion: 

    Our study demonstrated that cystic fibrosis, ATG induction, no AR-yr1 and prolonged transplant hospitalization were associated with the development of post-transplant MBI.  Importantly, MBI was associated with increased graft loss and death.  In the era of improved detection, isolation of mycobacteria has become more common and appears to have significant implications to the survival of the graft and patient after LT.


    Subject Category: O. Transplant infectious diseases

    Jennifer G. Katsolis, D.O.1, Cesar A. Keller, M.D.2, Francisco Alvarez, M.D.2, David B. Erasmus, M.D.2, Michael G. Heckman, M.S.3, Colleen S. Thomas, M.S.3, Jefree A. Shalev, B.S.4, John J. Cawley, M.M.Sc5, Michael R. Keating, M.D.1 and Salvador Alvarez, M.D.1, (1)Infectious Diseases, Mayo Clinic Florida, Jacksonville, FL, (2)Lung Transplant, Mayo Clinic Florida, Jacksonville, FL, (3)Biostatistics, Mayo Clinic Florida, Jacksonville, FL, (4)Transplant, Mayo Clinic Florida, Jacksonville, FL, (5)Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville, FL

    Disclosures:

    J. G. Katsolis, None

    C. A. Keller, None

    F. Alvarez, None

    D. B. Erasmus, None

    M. G. Heckman, None

    C. S. Thomas, None

    J. A. Shalev, None

    J. J. Cawley, None

    M. R. Keating, None

    S. Alvarez, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.