Mycobacterium abscessus infection has been associated with variable outcomes following lung transplantation. M. abscessus comprises three subspecies (M. abscessus subsp abscessus, M. abscessus subsp massiliense, and M. abscessus subsp bolletii). We investigated whether lung transplantation outcome in cystic fibrosis (CF) patients in a single centre was related to the M. abscessus subspecies and genetic cluster.
CF patients with chronic M. abscessus infection transplanted at Great Ormond Street Hospital between 2004 and 2017 were retrospectively examined. All M. abscessus isolates were identified to subspecies level by polymerase chain reaction (PCR) and sequencing. Genetic cluster was determined by variable number tandem repeat (VNTR) profiling and whole genome sequencing (WGS), sequence type (ST) inferred from WGS.
13 patients with chronic M. abscessus infection underwent heart/lung or lung transplantation. Subspecies identification showed n=1 with M. abscessus bolletii, n=5 with M. abscessus massiliense and n=7 with M. abscessus abscessus infection. Eight (62%) patients (one with M.abscessus massiliense and 7 with M. abscessus abscessus) died post lung transplant. The patient with M. abscessus bolletii and three patients with M. abscessus massiliense did well post-transplant. One patient with M. abscessus massiliense is receiving on-going treatment.
Dramatically worse outcomes are observed in patients infected with M. abscessus subspecies abscessus, the majority of whom were infected with ST-1 and ST-26 strains. Patients infected with other M. abcsessus strains can have acceptable outcomes.

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