B69-23 Beyond Contraindication : Incidence, Outcomes And Management Of Mycobacterium Abscessus In Lung Transplantation - A Narrative Review

Abstract Introduction Mycobacterium abscessus (MAB) infection has traditionally been viewed as a contraindication to lung transplantation due to its treatment challenges and potential to compromise the lung allograft. Despite the advent of newer therapeutic agents, there remains a paucity of literature to enhance the current nature of disease in lung transplant recipients. This review aims to contribute to the existing body of knowledge. Methods A PubMed search was conducted to identify studies published within the past decade up to May 2025, focusing on lung transplant recipients diagnosed with MAB. Extracted data included incidence, patient demographics, risk factors, subspecies differentiation, treatment approaches, and clinical outcomes. Results MAB infection in lung transplant recipients is uncommon (∼1 per 1000 patient-years) but significantly affects both patient survival and graft function. Pre-transplant colonization with MAB markedly increases the risk of post-transplant infection (odds ratios ∼2.4 to 7.5). Active MAB disease is associated with poorer post-transplant outcomes. Compared to uninfected recipients, those with active post-transplant MAB infection exhibit reduced survival rates (∼72% vs. 85-90% at 1 year; ∼45-50% vs. 55-60% at 5 years). In contrast, patients who underwent transplantation following successful MAB eradication demonstrated outcomes comparable to uninfected individuals, with no reported mortality. Subspecies analysis revealed that M. abscessus massiliense responds more favorably to treatment and may be associated with improved outcomes. Conclusion Based on this review, MAB infection should not disqualify patients from consideration for LTx. Emerging therapies offer a more optimistic outlook for managing this challenging infection, with encouraging survival rates and acceptable post-transplant outcomes in patients treated for this infection. Ongoing surveillance and tailored immunosuppressive strategies remain essential. This abstract is funded by: None