Cryptococcal infections are infrequent but a cause of morbidity & mortality in transplant (T) recipients. Best treatment and the need for secondary prophylaxis are still debated. We describe incidence, clinical presentation, treatment and outcomes of kidney (K) T recipients with cryptococcal infections observed at our institution.

Materials & Methods: Retrospective analysis of cryptococcal infections observed in KT patients (Pts) from 01/01/2008 to 10/011/2017.

Results: 1413 KT were performed in the period 2008-2017. 12 cryptococcal infections were observed (incidence:0.85%). Pts were 3 males/9 females. Age: Median 53.87 (range 20-72) years. Donors: Deceased: 7 (58.3%); Living-related 3 (25 %) Living non-related 2(16.7%.%). Immunosuppression: 10 received induction with timoglobulin. Maintenance immunosuppression (IS): Tacrolimus (FK)- mycophenolic acid (MPA)- prednisone (P): 8 (67%), MPA-P/ FK-MPA-P- belatacept/ Belatacept MPA-P/ Sirolimus-FK-MPA-P: 1 each . Four Pts had rejections previous to cryptococcal infection (Median time before cryptococcosis: 344.5 (Range: 83-1022) days). Time to infection after transplantation: Median 27.37 (range 3.2-84.3) months. Clinical forms: Meningeal: 6 (50%); Disseminated: 4 (33.3%); Pulmonary: 1 (8.3%); Pleural: 1 (8.3%). Median CD4 count at diagnosis: 88/mm3 (range 47-172). One Pt had a post-mortem diagnosis. Treatment: Induction: Liposomal Amphotericin B (L-AmB) 9 Pts; L-AmB+Fluconazole: 2 pt. . IS was temporarily minimized on all Pts until infection was controlled. Consolidation: Fluconazole 11 Pts. (2 pt. still on treatment), 9 pt. completed treatment (median: 12 (range 8,5-20) months,). Outcomes: All treated Pts (11/11) cured. 9 Pts maintained a functioning graft. Of these, 7 completed treatment (with no secondary prophylaxis) with no relapse of follow-up (FU). Median FU: 13,17 (range 3,44-72,33) months. 2 Pts lost the graft on FU (unrelated to cryptococcosis), and 1 Pt died of unrelated cause. Conclusion: Treatment with L-AmB (with or without fluconazole) followed by fluconazole, combined with appropriate IS management was successful in all forms of cryptococcal infection. No relapses were observed in Pts with treatment completed and no secondary prophylaxis.

CITATION INFORMATION: Radisic M., Pujato N., Dotta A., Livia Franzini R., Bravo M., Rodriguez Rilo L., Giampieri C., Leon L., Rial M., Casadei D. Cryptococcal Infections in Kidney Transplant Recipients. A Single Center Experience Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress