CHEST Guidelines-Outcomes-of-a-Peri--and-Postoperative-Management-P

Outcomes-of-a-Peri--and-Postoperative-Management-P

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In a study published by researchers at Toronto General Hospital, a peri- and postoperative management protocol was assessed for lung transplant recipients (LTRs) dealing with non-tuberculous mycobacteria pulmonary disease (NTM-PD). The significance of NTM is growing among this patient group, given the increased morbidity and mortality risks associated with lung transplantation and the subsequent immunosuppressive therapy. <br /><br />The retrospective cohort study included 230 patients who underwent lung transplants between January 2013 and December 2014, with a follow-up period until December 2017. Researchers identified that 7.4% of patients had a history of NTM-PD pre-transplant, with the mycobacterium avium-intracellular complex (MAC) being predominant. <br /><br />Eighteen patients were treated for peri-transplantation NTM-PD using a protocol that included macrolide-based antibiotics (azithromycin), ethambutol, and fluoroquinolones. Of those, 94.4% showed clinical and radiological stability, with the majority completing the 12-month therapy successfully.<br /><br />The study compared those with peritransplantation NTM-PD to those without, finding no significant increase in mortality rates for those following the treatment protocol. Similarly, the presence of granulomas or pretransplantation NTM cases did not significantly influence post-transplantation survival outcomes or the incidence of chronic lung allograft dysfunction (CLAD).<br /><br />The findings propose that lung transplantation, supported by the management protocol, could serve as a safe intervention for patients with NTM-PD, offering a means to manage the condition effectively without increasing risks of post-transplant complications. Researchers suggest that proper management can potentially act as a curative treatment for NTM-PD when combined with lung transplantation, particularly for those with MAC, as the protocol helps eliminate infection and curtail progression.

Keywords

lung transplant

non-tuberculous mycobacteria

NTM-PD

Toronto General Hospital

immunosuppressive therapy

macrolide antibiotics

mycobacterium avium-intracellular complex

chronic lung allograft dysfunction

perioperative management

lung transplantation protocol