Outcomes Following Reduction of Immunosuppression in Solid Organ Transplant Recipients with Cryptococcosis.
1Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
2VAMC, Birmingham, AL
Meeting: 2017 American Transplant Congress
Abstract number: B105
Keywords: Fungal infection, Immunosuppression, Outcome
Session Information
Session Name: Poster Session B: Bacteria, Fungi, Parasites
Session Type: Poster Session
Date: Sunday, April 30, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Background: Cryptococcosis (crypto) is the third most common fungal infection in solid organ transplant (SOT) recipients. Although reduction of immunosuppression (IS) may improve patient outcomes for some infections (eg, CMV, BK viremia), the impact of reduction of IS on outcomes in pts with crypto is unclear.
Methods: We evaluated SOT pts with crypto at our institution from 1996-2013. Inclusion required clinical or radiographic evidence of disease and one of the following: 1) positive culture of C. neoformans; 2) positive histopathology; or 3) positive serum/CSF crypto antigen. Data included transplant type, infection site, change of IS and outcomes. Change of IS was classified as discontinuation, <50% or ≥50% dose reduction of any drug that was sustained for ≥72 hours within 14 days of crypto diagnosis. Primary outcome was clinical response at 10 weeks. Mortality was defined as all-cause at 90 days.
Results: We identified 107 crypto cases. Mean age was 54.5 years; 77.6% were white and 66% male. The most common allograft was kidney (58%), then liver (17.8%), heart (16%) and lung (12.2%). CNS infection occurred in 64 (60%), with lung involvement in 44 (41%). IS reduction data were available for 63 (57%) pts. Any IS reduction for at least one drug was seen in 51 (80.1%) pts, with discontinuation in 40%; ≥50% reduction in 46% and <50% reduction in 38%. Clinical response at 10 wks was similar among groups: discontinuation (68% vs 78.8%); ≥50% reduction (73% vs 75.9%); and <50% reduction (83.3% vs 70.2%) with and without IS reduction, respectively. Mortality at 90 days was 35% and similar among groups. No cases of immune reconstitution syndrome were identified.
| Drug | Reduced <50% | Reduced ≥50% | Discontinued |
| Prednisone | 4/59 | 4/59 | 0/59 |
| Tacrolimus | 11/54 | 11/54 | 15/54 |
| MMF | 9/51 | 14/51 | 8/51 |
| Azathioprine | 0/5 | 2/5 | 1/5 |
| Cyclosporine | 0/5 | 1/5 | 3/5 |
| Other | 0/3 | 0/3 | 3/3 |
Conclusions: Clinical response was similar in pts who had reductions in IS, with the greatest benefit seen in pts who had <50% reduction of one drug. Our study is underpowered and data were unavailable on >40% of pts. Larger prospective studies are needed to fully ascertain the impact of IS reduction on crypto outcomes.
CITATION INFORMATION: Bryant P, Pappas P, Huisingh C, Mannon R, Locke J, Wille K, Eckhoff D, Tallaj J, Baddley J. Outcomes Following Reduction of Immunosuppression in Solid Organ Transplant Recipients with Cryptococcosis. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Bryant P, Pappas P, Huisingh C, Mannon R, Locke J, Wille K, Eckhoff D, Tallaj J, Baddley J. Outcomes Following Reduction of Immunosuppression in Solid Organ Transplant Recipients with Cryptococcosis. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-following-reduction-of-immunosuppression-in-solid-organ-transplant-recipients-with-cryptococcosis/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress