title: Unrecognized pretransplant and donor‐derived cryptococcal disease in organ transplant recipients.
abstract: BACKGROUND
  Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known.
  
  
  METHODS
  Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days after transplantation, respectively.
  
  
  RESULTS
  Very early-onset disease developed in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6% (5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcus isolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor&#x2010;acquired infection.
  
  
  CONCLUSIONS
  A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.
authors.affiliation: VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
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: Graeme N
authors.initials: GN
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authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Jyoti
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authors.lastname: Somani
authors.forename: Krishan L
authors.initials: KL
authors.lastname: Gupta
authors.forename: Ramon
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authors.lastname: del Busto
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Costi D
authors.initials: CD
authors.lastname: Sifri
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: George T
authors.initials: GT
authors.lastname: John
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pursell
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
authors.forename: Michele I
authors.initials: MI
authors.lastname: Morris
authors.forename: Lorraine A
authors.initials: LA
authors.lastname: Dowdy
authors.forename: Patricia
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authors.lastname: Munoz
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Susan L
authors.initials: SL
authors.lastname: Orloff
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Sally H
authors.initials: SH
authors.lastname: Houston
authors.forename: Dannah
authors.initials: D
authors.lastname: Wray
authors.forename: Shirish
authors.initials: S
authors.lastname: Huprikar
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Johnson
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.forename: Raymund R
authors.initials: RR
authors.lastname: Razonable
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003453:Cryptococcosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D003454:Cryptococcus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D013997:Time Factors; D014019:Tissue Donors; D019737:Transplants / Q000009:adverse effects*