title: Cryptococcus neoformans in organ transplant recipients: impact of calcineurin-inhibitor agents on mortality.
abstract: Variables influencing the risk of dissemination and outcome of Cryptococcus neoformans infection were assessed in 111 organ transplant recipients with cryptococcosis in a prospective, multicenter, international study. Sixty-one percent (68/111) of the patients had disseminated infection. The risk of disseminated cryptococcosis was significantly higher for liver transplant recipients (adjusted hazard ratio [HR], 6.65; P=.048). The overall mortality rate at 90 days was 14% (16/111). The mortality rate was higher in patients with abnormal mental status (P=.023), renal failure at baseline (P=.028), fungemia (P=.006), and disseminated infection (P=.035) and was lower in those receiving a calcineurin-inhibitor agent (P=.003). In a multivariable analysis, the receipt of a calcineurin-inhibitor agent was independently associated with a lower mortality (adjusted HR, 0.21; P=.008), and renal failure at baseline with a higher mortality rate (adjusted HR, 3.14; P=.037). Thus, outcome in transplant recipients with cryptococcosis appears to be influenced by the type of immunosuppressive agent employed. Additionally, discerning the basis for transplant type-specific differences in disease severity has implications relevant for yielding further insights into the pathogenesis of C. neoformans infection in transplant recipients.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA 15240, USA. nis5@pitt.edu
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Francoise
authors.initials: F
authors.lastname: Dromer
authors.forename: Krishan L
authors.initials: KL
authors.lastname: Gupta
authors.forename: George T
authors.initials: GT
authors.lastname: John
authors.forename: Ramon
authors.initials: R
authors.lastname: del Busto
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Jyoti
authors.initials: J
authors.lastname: Somani
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pursell
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
authors.forename: Patricia
authors.initials: P
authors.lastname: Munoz
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.forename: Sally
authors.initials: S
authors.lastname: Houston
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Dannah
authors.initials: D
authors.lastname: Wray
authors.forename: Susan
authors.initials: S
authors.lastname: Orloff
authors.forename: Lorraine A
authors.initials: LA
authors.lastname: Dowdy
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Joseph
authors.initials: J
authors.lastname: Heitman
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D003453:Cryptococcosis / Q000382:microbiology* / Q000401:mortality*; D003455:Cryptococcus neoformans / Q000187:drug effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents