Risk Factors for Cryptococcal Disease in Transplant as Compared with Non-Transplant Patients: A Single Center Study.
1David Geffen School of Medicine at UCLA, Los Angeles, CA
2UCLA Pathology &
Laboratory Medicine, Los Angeles, CA
Meeting: 2017 American Transplant Congress
Abstract number: B110
Keywords: Fungal infection, Immunosuppression, Mortality
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
Purpose: To examine clinical characteristics of non-HIV, immunocompromised patients diagnosed with cryptococcal disease, including solid-organ transplant (SOT) recipients.
Methods: We performed retrospective chart review of non-HIV, immunocompromised patients with laboratory or microbiological evidence of cryptococcal disease at UCLA Ronald Reagan and Santa Monica Hospitals between March 2015 and January 2016. Cryptococcal antigen (Crag) testing was performed by Lateral Flow Assay (IMMY).
Results: 20 patients with a positive serum or CSF cryptococcal antigen or a culture growing Cryptococcus spp. were identified. 8 (40%) patients were SOT recipients at the time of diagnosis (3 kidney, 1 kidney/pancreas, 2 liver, and 2 lung). 50% of SOT recipients received induction with ATG, 25% with basiliximab, and 25% no induction. 62.5% SOT recipients had been treated for rejection prior to development of infection, 2 with rituximab, 1 with belatacept, 1 with ATG, and 1 with pulse methylprednisolone. One SOT recipient developed disease within 1 year of transplant, 3 between 1-2 years post-transplant, and 4 more than 5 years post-transplant. 25% died, both diagnosed post-mortem. 50% of non-SOT patients died with cryptococcal infection contributing directly to mortality.
Conclusions: Cryptococcal disease continues to cause significant morbidity in affected patients. Mortality rate is high in pre-transplant patients with cirrhosis. Infection is associated with augmentation of immune suppression with ATG and steroid pulse, as well as with less traditional immune suppression agents including rituximab and belatacept. Future studies including a multicenter review of patients will be pursued to determine the strength of this association, which may have important implications for patients screening and consideration of prophylaxis when immune suppression is increased.
| Characteristic | SOTrecipient
(n=8) |
Non-SOT
(n=12) |
| Median age (range) | 53 (50-70) | 64 (38-91) |
| Male sex | 4 (50%) | 4 (33.3%) |
| Identified on culture | 5 (62.5%) | 10 (83.3%) |
| C. neoformans | 3 (37.5%) | 9 (75.0%) |
| Serum Crag positive (if tested) | 7/7 (100%) | 9/10 (90%) |
| Peak Crag >1:512 | 7/7 (100%) | 4/10 (40%) |
| Pulmonary disease | 6 (75%) | 7 (58.3%) |
| CNS disease | 1 (12.5%) | 2 (20.0%) |
| Died | 2 (25.0%) | 6 (50.0%) |
CITATION INFORMATION: Beaird O, Garner O, Humphries R, Schaenman J. Risk Factors for Cryptococcal Disease in Transplant as Compared with Non-Transplant Patients: A Single Center Study. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Beaird O, Garner O, Humphries R, Schaenman J. Risk Factors for Cryptococcal Disease in Transplant as Compared with Non-Transplant Patients: A Single Center Study. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-cryptococcal-disease-in-transplant-as-compared-with-non-transplant-patients-a-single-center-study/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress