Longworth S A, Vinnard C, Lee I, Sims K D, Barton T D, Blumberg E A
Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Transpl Infect Dis. 2014 Feb;16(1):76-83. doi: 10.1111/tid.12170. Epub 2013 Dec 19.
The epidemiology of nontuberculous mycobacteria (NTM) disease in solid organ transplant recipients is poorly defined.
We identified all solid organ transplant recipients with NTM disease at a single center over a 7.5-year period, and collected data on patient demographics, co-morbidities, immunosuppressive medications, and rejection. We conducted a case-control study to identify risk factors for disease, matching 3 control patients to each case patient by date of transplantation.
A total of 34 cases of NTM disease occurred during the study period, involving 6 single lung, 13 bilateral lung, 8 heart, 4 liver, 2 kidney, and 1 pancreas-kidney recipients. Cases were predominantly male (24/34), with a median age of 55 years (interquartile range [IQR]: 46-61 years), and developed after a median of 8 months post transplantation (IQR: 2-87 months). Mycobacterium abscessus and Mycobacterium avium complex were the most common pathogens, and the lung (including pleura) was the most common site of disease. In the adjusted case-control analysis, lung transplant recipients had the highest risk of NTM disease.
Additional studies are needed to evaluate the role of targeted surveillance measures for NTM disease in high-risk patients, particularly lung transplant recipients, and to characterize the mechanisms of disease acquisition.
实体器官移植受者中非结核分枝杆菌（NTM）病的流行病学情况尚不明确。
我们在一个单一中心确定了7.5年间所有患有NTM病的实体器官移植受者，并收集了患者人口统计学、合并症、免疫抑制药物和排斥反应的数据。我们进行了一项病例对照研究以确定疾病的危险因素，按移植日期为每例病例患者匹配3例对照患者。
研究期间共发生34例NTM病，涉及6名单肺移植、13例双肺移植、8例心脏移植、4例肝移植、2例肾移植和1例胰肾联合移植受者。病例以男性为主（24/34），中位年龄55岁（四分位间距[IQR]：46 - 61岁），发病时间中位数为移植后8个月（IQR：2 - 87个月）。脓肿分枝杆菌和鸟分枝杆菌复合群是最常见的病原体，肺（包括胸膜）是最常见的发病部位。在调整后的病例对照分析中，肺移植受者患NTM病的风险最高。
需要进一步研究以评估针对高危患者，特别是肺移植受者的NTM病靶向监测措施的作用，并明确疾病获得的机制。
