Nontuberculous Mycobacterial Disease Is Not a Contraindication to Lung Transplantation in Patients With Cystic Fibrosis: A Retrospective Analysis in a Danish Patient Population T. Qvist, T. Pressler, V.O. Thomsen, M. Skov, M. Iversen, and T.L. Katzenstein ABSTRACT Whether nontuberculous mycobacterial (NTM) disease is a contraindication to lung transplantation remains controversial. We conducted a nationwide study to evaluate the clinical importance of NTM infection among lung transplant patients with cystic fibrosis (CF) in Denmark and to determine if NTM infection poses a contraindication to lung transplantation. All CF patients with current or prior NTM who had undergone lung transplantation were identified. Out of 52 lung transplant patients with CF 9 (17%) had NTM disease. Five patients had known infection at the time of transplantation. Two of these died of non-NTM-related causes whereas two developed deep Mycobacterium abscessus wound infections and one was transiently culture negative until M abscessus was reactivated. One patient was subsequently cured; the other two remained on therapy with good performance status. The study supports the contention that CF patients with prior or active NTM can undergo lung transplantation although postoperative complications can be expected. N ONTUBERCULOUS MYCOBACTERIA (NTM) are opportunistic pathogens that can cause severe, yet subtle, disease in cystic fibrosis (CF) patients. NTM disease has previously been considered an absolute con- traindication to lung transplantation, 1,2 but case reports challenging this view have been published, establishing that transplantation can sometimes be feasible with acceptable outcome. 3 Incidence rates of NTM in the CF population vary geographically, with some investigators reporting stable rates, while others report substantially increased rates. 4,5 Indications for treatment, drug com- binations, and duration of treatment are not clearly defined. 6 There are 460 CF patients in Denmark attending two CF centers approximately every 4 weeks for outpatient visits. During the last 19 years, 34 patients have been found NTM-positive, in sputum or bronchoalveolar la- vage (BAL) samples. 4 The aim of the present study was to investigate the prevalence and clinical significance of NTM infection in CF patients undergoing lung transplan- tation. To do this, we evaluated the clinical outcomes of all lung transplant patients with CF in Denmark, who had at any time pre- or posttransplantation fulfilled the criteria for NTM disease. METHODS Patient Population All CF patients who underwent lung transplantation at The Copenhagen Lung Transplant Unit between October 1994 and January 2011 were studied. Patients were cross-checked with the results of a recent analysis of patients testing positive for NTM over the past 19 years. 4 Data on clinical manifestations of NTM infections, treatment regimens, and clinical outcomes were ex- tracted from patient records. Details of recipient and donor selection and management and transplant procedures have been described previously. 7 Induction therapy was given regardless of NTM infection, and different induction agents have been in use since 1992. Antithymocyte globulin (ATG [rabbit derived], bioMérieux, Marcy l’Etoile, From the Copenhagen CF Centre (T.Q., T.P., M.S.), Copenhagen University Hospital Rigshospitalet; International Reference Labora- tory of Mycobacteriology (V.O.T.), Statens Serum Institute; Section of Heart and Lung Transplantation (M.I.), Department of Cardi- ology, Copenhagen University Hospital Rigshospitalet; and De- partment of Infectious Diseases (T.L.K.), Copenhagen University Rigshospitalet, Copenhagen, Denmark. Address reprint requests to Tavs Qvist, Copenhagen CF Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail: tavs. qvist@gmail.com 0041-1345/13/$–see front matter © 2013 by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.transproceed.2012.02.035 360 Park Avenue South, New York, NY 10010-1710 342 Transplantation Proceedings, 45, 342–345 (2013)