TY - JOUR
T1 - Cryptococcus neoformans in organ transplant recipients
T2 - Impact of calcineurin-inhibitor agents on mortality
AU - Singh, Nina
AU - Alexander, Barbara D.
AU - Lortholary, Olivier
AU - Dromer, Françoise
AU - Gupta, Krishan L.
AU - John, George T.
AU - Del Busto, Ramon
AU - Klintmalm, Goran B.
AU - Somani, Jyoti
AU - Lyon, G. Marshall
AU - Pursell, Kenneth
AU - Stosor, Valentina
AU - Muňoz, Patricia
AU - Limaye, Ajit P.
AU - Kalil, Andre C.
AU - Pruett, Timothy L.
AU - Garcia-Diaz, Julia
AU - Humar, Atul
AU - Houston, Sally
AU - House, Andrew A.
AU - Wray, Dannah
AU - Orloff, Susan
AU - Dowdy, Lorraine A.
AU - Fisher, Robert A.
AU - Heitman, Joseph
AU - Wagener, Marilyn M.
AU - Husain, Shahid
AU - Antoine, Corinne
AU - Benoît, Barrou
AU - Heng, Anne Elisabeth
AU - Legendre, Christophe
AU - Michelet, Christian
AU - Ponceau, Bénédicte
AU - Ouali, Nacéra
AU - Stern, Marc
AU - Sheppard, Theresa
AU - Lyon, Marshall
N1 - Funding Information:
Potential conflicts of interest: L.A.D. has received research support from Enzon and Astellas. S. Husain has received research support from Enzon. G.M.L. is on the speaker’s bureaus of Pfizer and Astellas and has received research support from Merck and Astellas. O.L. is on the speaker’s bureaus of Pfizer and Astellas. K.P. is on the speaker’s bureaus for Merck, Pfizer, and Schering-Plough. N.S. has received research grant support from Schering-Plough and Enzon. All other authors report no conflicts of interest.
Funding Information:
Financial support: National Institutes of Health/National Institute of Allergy and Infectious Diseases (award R01 AI054719-01 to N.S.). a Study group members are listed after the text.
PY - 2007/3/1
Y1 - 2007/3/1
N2 - Variables influencing the risk of dissemination and outcome of Cryptococcus neoformans infection were assessed in 111 organ transplant recipients with cryptococcosis in a prospective, multicenter, international study. Sixty-one percent (68/111) of the patients had disseminated infection. The risk of disseminated cryptococcosis was significantly higher for liver transplant recipients (adjusted hazard ratio [HR], 6.65; P = .048). The overall mortality rate at 90 days was 14% (16/111). The mortality rate was higher in patients with abnormal mental status (P = .023), renal failure at baseline (P = .028), fungemia (P = .006), and disseminated infection (P = .035) and was lower in those receiving a calcin eurin-inhibitor agent (P = .003). In a multivariable analysis, the receipt of a calcineurin-inhibitor agent was independently associated with a lower mortality (adjusted HR, 0.21; P = .008), and renal failure at baseline with a higher mortality rate (adjusted HR, 3.14; P = .037). Thus, outcome in transplant recipients with cryptococcosis appears to be influenced by the type of immunosuppressive agent employed. Additionally, discerning the basis for transplant type-specific differences in disease severity has implications relevant for yielding further insights into the pathogenesis of C. neoformans infection in transplant recipients.
AB - Variables influencing the risk of dissemination and outcome of Cryptococcus neoformans infection were assessed in 111 organ transplant recipients with cryptococcosis in a prospective, multicenter, international study. Sixty-one percent (68/111) of the patients had disseminated infection. The risk of disseminated cryptococcosis was significantly higher for liver transplant recipients (adjusted hazard ratio [HR], 6.65; P = .048). The overall mortality rate at 90 days was 14% (16/111). The mortality rate was higher in patients with abnormal mental status (P = .023), renal failure at baseline (P = .028), fungemia (P = .006), and disseminated infection (P = .035) and was lower in those receiving a calcin eurin-inhibitor agent (P = .003). In a multivariable analysis, the receipt of a calcineurin-inhibitor agent was independently associated with a lower mortality (adjusted HR, 0.21; P = .008), and renal failure at baseline with a higher mortality rate (adjusted HR, 3.14; P = .037). Thus, outcome in transplant recipients with cryptococcosis appears to be influenced by the type of immunosuppressive agent employed. Additionally, discerning the basis for transplant type-specific differences in disease severity has implications relevant for yielding further insights into the pathogenesis of C. neoformans infection in transplant recipients.
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U2 - 10.1086/511438
DO - 10.1086/511438
M3 - Article
C2 - 17262720
AN - SCOPUS:33847064677
SN - 0022-1899
VL - 195
SP - 756
EP - 764
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 5
ER -