Allograft loss in renal transplant recipients with cryptococcus neoformans associated immune reconstitution syndrome.
This study describes the association of allograft loss and immune reconstitution syndrome (IRS) in the course of Cryptococcosis neoformans infection in renal transplant recipients. Patients comprised 54 renal allograft recipients with cryptococcosis in a prospective, multicenter study. IRS developed in 5.5% (3/54) of the renal transplant recipient with C. neoformans infection. The renal allograft was lost to chronic rejection in 66% (2/3) of the patients with cryptococcosis who developed IRS compared to 5.9% (3/51) of those who did not (P=0.012). Kaplan-Meier survival analysis showed that subsequent to cryptococcal infection the probability of allograft survival was significantly lower in patients who developed IRS compared to those who did not develop IRS (P=0.0004). Temporal association of graft loss with IRS suggests a common pathophysiologic basis for these entities with implications relevant for the optimal management of renal transplant recipients with cryptococcosis.
Singh
Nina
N
University of Pittsburgh Medical Center, Pittsburgh, PA, USA. nis5@pitt.edu
Lortholary
Olivier
O
Alexander
Barbara D
BD
Gupta
Krishan L
KL
John
George T
GT
Pursell
Kenneth
K
Munoz
Patricia
P
Klintmalm
Goran B
GB
Stosor
Valentina
V
delBusto
Ramon
R
Limaye
Ajit P
AP
Somani
Jyoti
J
Lyon
Marshall
M
Houston
Sally
S
House
Andrew A
AA
Pruett
Timothy L
TL
Orloff
Susan
S
Humar
Atul
A
Dowdy
Lorraine
L
Garcia-Diaz
Julia
J
Fisher
Robert A
RA
Husain
Shahid
S
D003453:Cryptococcosis / Q000150:complications* / Q000628:therapy; D003455:Cryptococcus neoformans; D006084:Graft Rejection / Q000209:etiology* / Q000276:immunology / Q000382:microbiology; D006801:Humans; D007154:Immune System Diseases / Q000150:complications*; D007108:Immune Tolerance; D016030:Kidney Transplantation; D009894:Opportunistic Infections / Q000150:complications*; D013577:Syndrome