title: Allograft loss in renal transplant recipients with cryptococcus neoformans associated immune reconstitution syndrome.
abstract: 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.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, USA. nis5@pitt.edu
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Krishan L
authors.initials: KL
authors.lastname: Gupta
authors.forename: George T
authors.initials: GT
authors.lastname: John
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pursell
authors.forename: Patricia
authors.initials: P
authors.lastname: Munoz
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
authors.forename: Ramon
authors.initials: R
authors.lastname: delBusto
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: Jyoti
authors.initials: J
authors.lastname: Somani
authors.forename: Marshall
authors.initials: M
authors.lastname: Lyon
authors.forename: Sally
authors.initials: S
authors.lastname: Houston
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Susan
authors.initials: S
authors.lastname: Orloff
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.forename: Lorraine
authors.initials: L
authors.lastname: Dowdy
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
mesh_terms: 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