Mycobacterium abscessus

Question

Can patients with Mycobacterium abscessus colonisation be transplanted ?

Answer

Dear Ecorn user,

Thank you for your question.
Atypical mycobacteria such as Mycobacterium abscessus, Mycobacterium avium, Mycobacterium simiae etc are environmental bacterial micro-organisms. They are related to Mycobacterium tuberculosus (the bacterium that causes tuberculosis) but only rarely cause diseases in healthy persons. They are sometimes isolated from the airways of CF-patients (this is called colonisation) and in a minority of cases (less than 10%) this leads to an infection with disease signs and radiological abnormalities (this is called infection). In the latter case prolonged treatment with multiple antibiotics is indicated. Also after lung transplant atypical mycobacteria can cause infection in CF-patients. Patients who were colonised with Mycobacterium abscessus pre-transplant are at higher risk of developing an infection with M. abscessus post-transplant. In a recent study in CF patients who underwent lung transplant, 18 CF-patients (20% of the group examined) were colonised with atypical mycobacteria pre-transplant (half of them were colonised with M. abscessus). In 7 of these 18 patients atypical mycobacteria were again isolated post-transplant. and 4 of the 7 patients had signs of infection (twice with M. abscessus).
Several reports describe CF-patients with M. abscessus infection post lung transplant and document a difficult disease course with multiple complications such as wound infection, infection of the sternum and the chest wall, pleural infection, disseminated infection and early death despite agressive treatment with antibiotics and surgery. For these reasons colonisation with M. abscessus prior to transplant is a relative contra-indication for transplant. This means that there is some reluctancy to offer a transplant to such patients and some transplant centres will refuse these patients for transplant. The chance of not being considered for transplan is greater in case of colonisation with M. abscessus resistant to antibiotics. An active infection with M. abscessus or other atypical mycobacterium prior to transplant is an absolute contra-indication for lung transplant. This means that without succesful treatment these patients can not be transplanted.
The ultimate decission whether or not to transplant lungs in CF-patients colonised with M. abscessus or any other atypical mycobacterium remains an individual decision depending on the one hand on the policy a in a specific transplant centre and on the other hand on the presence of additional risk factors in the patient.
There is thus no black and white answer to your question as to whether patients with M. abscessus colonisation or infection can be transplanted and for a specific individual answer we suggest that you consult the transplant centre working together with your CF-centre.
Sincerely yours
Prof. L. Dupont

10.11.2008