Impact of Doxycycline Prophylaxis on Reducing Ureaplasma and Mycoplasma ‐Related Complications in Lung Transplant Recipients

BACKGROUND: Ureaplasma and Mycoplasma species (spp.) infections have been associated with increased morbidity and mortality in lung transplant (LTx) recipients due to their association with hyperammonemia syndrome (HS) and wound dehiscence. This study aims to assess the clinical outcomes in LTx recipients treated with preventative doxycycline. METHODS: We conducted a single-center retrospective review of LTx recipients from January 2020 to February 2024. In November 2023, our center began administering doxycycline prophylaxis (ppx) postoperatively until bronchoalveolar lavage PCR results for Mycoplasma and Ureaplasma spp. were available. Doxycycline was discontinued if the PCR was negative and continued for 14 days if positive. RESULTS: A total of 98 LTx recipients were reviewed, with 3 excluded due to death before surveillance. Of these, 70 tested negative for Mycoplasma and Ureaplasma spp., 8 were not tested, and among the 17 positives, 11 received doxycycline ppx. The incidence of HS was lower in the ppx group (0% vs. 50%). The ppx group had shorter median duration of mechanical ventilation (MV) (3 vs. 20 days), ICU stay (9 vs. 22 days), and hospital stay (24 vs. 30 days). No significant difference was found in the rates of anastomotic dehiscence (18% vs. 17%). CONCLUSIONS: Doxycycline ppx was associated with a lower incidence of HS, decreased duration of MV, and shorter ICU and hospital length of stay in this cohort of LTx recipients. These findings suggest that doxycycline, an inexpensive and relatively well-tolerated intervention, may prevent HS after LTx.