Management of nontuberculous mycobacteria in lung transplant cases: an international Delphi study

Huda Asif, Franck F. Rahaghi, Akihiro Ohsumi, Julie Philley, Amir Emtiazjoo, Takashi Hirama, Arthur W. Baker, Chin Chung Shu, Fernanda Silveira, Vincent Poulin, Pete Rizzuto, Miki Nagao, Pierre Régis Burgel, Steve Hays, Timothy Aksamit, Takeshi Kawasaki, Charles Dela Cruz, Stefano Aliberti, Takahiro Nakajima, Stephen RuossTheodore K. Marras, Gregory I. Snell, Kevin Winthrop, Mehdi Mirsaeidi

Research output: Contribution to journalArticlepeer-review


Rationale Nontuberculous mycobacterial (NTM) diseases are difficult-to-treat infections, especially in lung transplant (LTx) candidates. Currently, there is a paucity of recommendations on the management of NTM infections in LTx, focusing on Mycobacterium avium complex (MAC), M. abscessus and M. kansasii. Methods Pulmonologists, infectious disease specialists, LTx surgeons and Delphi experts with expertise in NTM were recruited. A patient representative was also invited. Three questionnaires comprising questions with multiple response statements were distributed to panellists. Delphi methodology with a Likert scale of 11 points (5 to −5) was applied to define the agreement between experts. Responses from the first two questionnaires were collated to develop a final questionnaire. The consensus was described as a median rating >4 or <−4 indicating for or against the given statement. After the last round of questionnaires, a cumulative report was generated. Results Panellists recommend performing sputum cultures and a chest computed tomography scan for NTM screening in LTx candidates. Panellists recommend against absolute contraindication to LTx even with multiple positive sputum cultures for MAC, M. abscessus or M. kansasii. Panellists recommend MAC patients on antimicrobial treatment and culture negative can be listed for LTx without further delay. Panellists recommend 6 months of culture-negative for M. kansasii, but 12 months of further treatment from the time of culture-negative for M. abscessus before listing for LTx. Conclusion This NTM LTx study consensus statement provides essential recommendations for NTM management in LTx and can be utilised as an expert opinion while awaiting evidence-based contributions.

Original languageEnglish (US)
Article number00377-2022
JournalERJ Open Research
Issue number2
StatePublished - Mar 1 2023

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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