This article is more than 5 years old. Information may no longer be current.
Cryptococcosis risk following solid organ transplantation highest in lung recipients
Click Here to Manage Email Alerts
Lung transplant recipients had a greater risk for developing cryptococcosis than other recipients of solid organ transplants, according to the results of a retrospective cohort study.
Although cryptococcosis is rare, researchers reported that the infection increased risk for death in solid organ transplant (SOT) recipients, particularly among those with nonkidney transplants.
“Traditionally cryptococcosis is most often associated with [HIV] infection; however, with the advent of effective antiretroviral therapy, the majority of cases in developed nations occur among nonHIV-infected patients, especially organ transplant recipients,” Infectious Diseases Society of America President William G. Powderly, MD, FIDSA, and colleagues wrote in Open Forum Infectious Diseases. “Results from the Transplant-Associated Infection Surveillance Network, a consortium of 23 U.S. transplant centers, showed that cryptococcosis is the third most common invasive fungal infection in SOT recipients, after invasive candidiasis and aspergillosis.”
Due to a lack of population-level data on cryptococcal disease in SOT recipients, Powderly and colleagues examined ICD-9 CM billing data from the Healthcare Cost and Utilization Project State Inpatient Databases of Florida, New York and California to gather more information on the epidemiology of cryptococcosis and cryptococcal meningitis. Their analysis included 42,634 adult patients who received SOTs at multiple hospitals across the three states from 2004 to 2012. The median follow-up duration was 1,295 days after SOT.
According to the data, 0.37% of patients had cryptococcal disease. Among them, 44% had meningitis.
The highest risk for cryptococcosis was among lung recipients (adjusted HR = 2.10; 95% CI, 1.21-3.60) compared with other patients. Additional risk factors for cryptococcosis included increasing age, diabetes mellitus (adjusted HR [aHR] = 1.95; 95% CI, 1.41-2.69) and having Medicaid or no insurance (aHR = 1.99; 95% CI, 1.27-3.11).
The median time to a cryptococcosis diagnosis was 464 days after transplantation. Very early onset within 30 days of transplantation occurred in 10.1% of patients and was more common in lung (191 days; range 7.5-1,816), heart (195 days; range 4-1,061) and liver transplant recipients (200 days; range 4-1,581) than in kidney transplant recipients (616 days; range 12-2,393; P < .001).
Further analyses adjusted for age, transplant type and other comorbidities showed that in-hospital mortality was more common in patients with cryptococcosis than in those without cryptococcosis (26% vs. 9.1%; aHR = 2.29; 95% CI, 1.68-3.11). The risk for death was highest among lung transplant recipients (aHR = 3.68; 95% CI, 3.28-4.12), followed by liver (aHR = 2.47; 95% CI, 2.26-2.71) and heart transplant recipients (aHR = 2.32; 95% CI, 2.11-2.65), compared with renal transplant recipients.
“This is the first study that provides population-level information on the epidemiology of cryptococcosis after SOT in the current era,” Powderly and colleagues concluded. “Future research should focus on screening algorithms and consider prophylactic strategies, especially in liver and lung transplant recipients at risk of very early onset disease.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts