Cryptococcus neoformans in organ transplant recipients: impact of calcineurin-inhibitor agents on mortality.
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.
Singh
Nina
N
University of Pittsburgh Medical Center, Pittsburgh, PA 15240, USA. nis5@pitt.edu
Alexander
Barbara D
BD
Lortholary
Olivier
O
Dromer
Francoise
F
Gupta
Krishan L
KL
John
George T
GT
del Busto
Ramon
R
Klintmalm
Goran B
GB
Somani
Jyoti
J
Lyon
G Marshall
GM
Pursell
Kenneth
K
Stosor
Valentina
V
Munoz
Patricia
P
Limaye
Ajit P
AP
Kalil
Andre C
AC
Pruett
Timothy L
TL
Garcia-Diaz
Julia
J
Humar
Atul
A
Houston
Sally
S
House
Andrew A
AA
Wray
Dannah
D
Orloff
Susan
S
Dowdy
Lorraine A
LA
Fisher
Robert A
RA
Heitman
Joseph
J
Wagener
Marilyn M
MM
Husain
Shahid
S
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
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents