Mycobacterium Abscessus in Lung Transplantation: Proceed with Caution

A 25-year old male patient with cystic fibrosis has developed progressive disease and his medical team is considering referral for lung transplantation. The patient has a history of pancreatic insufficiency and well controlled diabetes. He has been infected with Pseudomonas aeruginosa and Methicillin Sensitive Staphylococcus aureus. Some of his recent mycobacterial cultures have had low growth of Mycobacterium abscessus. Is this an appropriate candidate for lung transplantation? In recent years there has been an increase in atypical mycobacterial infections in patients with advanced lung disease, especially in patients with cystic fibrosis and bronchiectasis.1,2 In particular, Mycobacterium abscessus has been isolated with increasing frequency from patients. M. abscessus is inherently resistant to many antibiotics and has a propensity to lead to respiratory and wound infections. Treatment with multiple antibiotics, including but not limited to amikacin, imipenem, cefoxitin, macrolides, quinolones, doxycycline, linezolid and tigecycline, is frequently required.2 Toxicities are quite significant. Transplant programs are struggling to decide on whether patients with M. abscessus can be transplanted safely. Studies have attempted to identify risk factors for development of mycobacterial infections after lung transplantation. The only one that was found was the presence of M. abscessus prior to lung transplantation.