Unrecognized pretransplant and donor‐derived cryptococcal disease in organ transplant recipients.
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.
Sun
Hsin-Yun
HY
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA.
Alexander
Barbara D
BD
Lortholary
Olivier
O
Dromer
Francoise
F
Forrest
Graeme N
GN
Lyon
G Marshall
GM
Somani
Jyoti
J
Gupta
Krishan L
KL
del Busto
Ramon
R
Pruett
Timothy L
TL
Sifri
Costi D
CD
Limaye
Ajit P
AP
John
George T
GT
Klintmalm
Goran B
GB
Pursell
Kenneth
K
Stosor
Valentina
V
Morris
Michele I
MI
Dowdy
Lorraine A
LA
Munoz
Patricia
P
Kalil
Andre C
AC
Garcia-Diaz
Julia
J
Orloff
Susan L
SL
House
Andrew A
AA
Houston
Sally H
SH
Wray
Dannah
D
Huprikar
Shirish
S
Johnson
Leonard B
LB
Humar
Atul
A
Razonable
Raymund R
RR
Fisher
Robert A
RA
Husain
Shahid
S
Wagener
Marilyn M
MM
Singh
Nina
N
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*