Risk factors for nontuberculous mycobacteria infection in lung transplant recipients

The incidence and number of deaths of nontuberculous mycobacteria (NTM) infection in lung transplant recipients is on the rise. Risk factors for NTM infection after lung transplant are not well characterized. This was a retrospective, single-center case-control study including patients who underwent lung transplantation (LTx) at the China-Japan Friendship Hospital between March 2018 and April 2024. A total of 23 NTM infection patients and 474 controls were enrolled in the study. Cox regression analysis and competing risks models were used to identify risk factors for NTM infection after LTx. The incidence of antibody-mediated rejection (AMR) (26.1% versus 8.2%; p value = 0.012) was higher in the NTM infection group than in controls. A 1:2 propensity score matching resulted in 18 NTM infection patients and 36 controls. The incidence of AMR in NTM infection group remained higher than in controls. Univariable Cox regression analysis revealed that the occurrence of AMR (hazard ratio HR5.77; 95% confidence interval CI 1.45-23.00; p value = 0.013) and CLAD (HR 3.40; 95% CI 1.03–11.19; p value = 0.044) were risk factors for NTM infection. Adjusted multivariable Cox regression analysis demonstrated that the occurrence of AMR was independently associated with increased risk of NTM infection. Competitive risk models showed that LTRs with AMR had a substantially higher cumulative incidence of NTM infection. Our findings suggest a possible association between AMR and NTM infection. In addition, this study provides clinicians with relevant information regarding NTM infection in this setting.