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Cryptococcosis In Kidney Transplant Recipients: A Multicenter Retrospective Case-Control Study

L. Tardieu1, O. Lortholary2, F. Lanternier2, A. Scemla3, C. Rafat1

1Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Paris, France, 2Service de Maladies Infectieuses et Tropicales – Centre d’Infectiologie Necker-Pasteur, Hôpital Necker, APHP, Paris, France, 3Service de Transplantation Rénale, Hôpital Necker, APHP, Paris, France

Meeting: 2020 American Transplant Congress

Abstract number: A-182

Keywords: Fungal infection, Graft function, Kidney transplantation, Outcome

Session Information

Session Name: Poster Session A: All Infections (Excluding Kidney & Viral Hepatitis)

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Cryptococcosis is the third most common invasive fungal infection in organ transplant recipients.The clinical approach and prognosis has been previously investigated in the setting of solid organ transplantation, however the outcomes pertaining to kidney transplant patients has yet to be addressed specifically. We sought to assess kidney graft function following cryptococcosis and initial disease presentation.

*Methods: We performed a retrospective case-control study of adult patients diagnosed with cryptococcosis after kidney transplantation between 2002 and 2018 in France. One control patient was matched per case according to institution and transplant date.

*Results: Sixty patients were included. Patients were predominantly male (70 %) and were more likely to be highly sensitized (65%) compared to controls (22%, p<0.001). The median duration of follow-up from the date of cryptococcosis was 17 months [2.75 - 45.75 months]Two-year all-cause mortality was significantly higher in patients with cryptococcosis (43 %) than in control transplant patients (n=11/158, 6.9%) (p = 0.0001).Compared to the control group, patients who survived cryptococcosis had a higher risk of end-stage kidney disease [(25/53) vs (3/36) p = 0.003] and a lower kidney function (eGFR based on CKD-EPI: 35.5 ml/min/1.73m2 [8-69] vs 47.3 ml/min/1,73m2[15-89], p=0.03). Mechanisms of kidney graft function deterioration consisted chiefly in chronic graft dysfunction following cryptococcosis (n=5/43, 12%), graft rejection (n=4/43, 9%) and viral nephritis (n=3/43, 7%). 57 % of the patients presented with disseminated cryptococcosis or disease involving the central nervous system. 32% had pulmonary disease and 9 % had skin, soft-tissue, osteoarticular or urinary tract cryptococcosis. Canonical symptoms such as headaches and vomiting were mostly absent, affecting 45% of and 22% of the patients, respectively. The presence of fever was inconsistent (63%). Accordingly, 82% of the patients had a history of prior hospitalization for inaugural symptoms of cryptococcosis without a conclusive diagnosis being established, amounting to median diagnosis delay time of 35 days [9 -61 days].

*Conclusions: Cryptococcosis is associated with a negative impact on kidney transplant patients survival and kidney graft outcomes. Multiple causes of graft loss were identified including conditions connected to both over-immunosuppression and under-immunosuppression. Characteristic features pertaining to cryptococcosis may be missing upon inaugural presentation resulting in delayed diagnosis and increased morbidity.

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To cite this abstract in AMA style:

Tardieu L, Lortholary O, Lanternier F, Scemla A, Rafat C. Cryptococcosis In Kidney Transplant Recipients: A Multicenter Retrospective Case-Control Study [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/cryptococcosis-in-kidney-transplant-recipients-a-multicenter-retrospective-case-control-study/. Accessed May 10, 2025.

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