SOLID-ORGAN transplant recipients face a markedly higher risk of developing nontuberculous mycobacterial disease compared with the general population, and this risk translates into greater long-term mortality, according to findings from a large population-based cohort study.
The study analyzed data from 138,175 adults in Ontario, Canada, between 2002 and 2018, including 12,564 solid-organ transplant recipients and 125,611 matched controls. Participants were tracked for the development of nontuberculous mycobacterial disease, defined by microbiological evidence from blood, tissue, or respiratory samples, and for subsequent mortality.
Results showed that 2.9% of transplant recipients developed the disease compared with only 0.1% of matched controls. The risk was particularly pronounced among lung transplant recipients, who experienced a 177-fold higher likelihood of developing the infection compared with controls. Nonlung transplant recipients also had significantly increased risk, nearly nine times that of the general population.
The study further demonstrated that specific pathogens, including Mycobacterium avium complex and rapidly growing mycobacteria, were strongly linked to long-term mortality in both lung and nonlung transplant recipients. In patients lung transplant, infections with these organisms were associated with mortality hazard ratios of 1.66 and 2.33, respectively. In nonlung transplant recipients, the corresponding hazard ratios were 2.12 and 2.25.
The findings underscore the importance of vigilant surveillance and prevention strategies in transplant populations, particularly for lung transplant recipients who face the greatest burden of disease. Enhanced screening protocols, early detection, and targeted management may be key to improving outcomes in this vulnerable group.
Reference: Hosseini-Moghaddam S et al. Nontuberculous Mycobacterial Disease in Solid-Organ Transplant Recipients and the General Population. JAMA Netw Open. 2025;8(9):e2531563.
