Kesten S, Chaparro C
Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
Chest. 1999 Mar;115(3):741-5. doi: 10.1378/chest.115.3.741.
Immunosuppression and chronic lung disease are known risk factors for mycobacterial infection and might be expected to develop with an increased frequency in lung transplant recipients. We therefore sought to document the incidence and type of mycobacterial infections in a large lung transplant program.
A retrospective review of 219 transplant procedures (60 single lung transplants and 159 double lung transplants) in 210 patients was conducted. All patients had scheduled surveillance bronchoscopies at 3, 6, 9, 12, 18, and 24 months, and yearly thereafter. BAL samples were processed routinely for mycobacterium.
Eight patients (3.8%) had evidence of infection (5 men, 3 women; age range, 26 to 63 years). The reasons for transplant were obstructive lung disease (six), cystic fibrosis (one), and pulmonary fibrosis (one). Five recipients had infection in their native lungs; two of five cultured mycobacterium from BAL following transplantation. At least four of five patients had nontuberculous mycobacterium (one showed acid fast bacilli and granuloma on a biopsy specimen that was not sent for culture). None of the five developed disease (mean follow-up = 22 months; range, 3 to 30 months). The organisms were Mycobacterium avium complex (three), Mycobacterium xenopi (one), and unidentified (one). Of the three remaining patients who developed infection after transplantation, one grew Mycobacterium chelonae and the others grew Mycobacterium tuberculosis (both received double lung transplants and had no evidence of mycobacterium in their native lungs). The only definite symptomatic disease occurred in the patients with M tuberculosis, one of whom had evidence of dissemination. The patients with M tuberculosis responded to standard treatment. There have been no deaths due to mycobacterium.
Mycobacterial disease rarely occurs following lung transplantation. Cultures for mycobacterium in surveillance BALs in the absence of symptoms are likely unnecessary.
免疫抑制和慢性肺病是已知的分枝杆菌感染风险因素，预计肺移植受者中其发生频率会增加。因此，我们试图记录一个大型肺移植项目中分枝杆菌感染的发生率和类型。
对210例患者的219例移植手术（60例单肺移植和159例双肺移植）进行回顾性研究。所有患者在3、6、9、12、18和24个月时安排了监测支气管镜检查，此后每年进行一次。支气管肺泡灌洗（BAL）样本常规处理以检测分枝杆菌。
8例患者（3.8%）有感染证据（5例男性，3例女性；年龄范围26至63岁）。移植原因是阻塞性肺病（6例）、囊性纤维化（1例）和肺纤维化（1例）。5例受者在其原生肺中发生感染；其中5例中有2例在移植后BAL培养出分枝杆菌。5例患者中至少4例感染非结核分枝杆菌（1例活检标本显示抗酸杆菌和肉芽肿，但未送检培养）。这5例患者均未发病（平均随访22个月；范围3至30个月）。病原体为鸟分枝杆菌复合群（3例）、偶发分枝杆菌（1例）和未鉴定的（1例）。其余3例移植后发生感染的患者中，1例培养出龟分枝杆菌，另2例培养出结核分枝杆菌（均接受双肺移植，原生肺中无分枝杆菌证据）。唯一明确有症状的疾病发生在结核分枝杆菌感染患者中，其中1例有播散证据。结核分枝杆菌感染患者对标准治疗有反应。没有因分枝杆菌感染导致的死亡。
肺移植后分枝杆菌病很少发生。在无症状情况下，监测BAL中的分枝杆菌培养可能没有必要。
