Premium
Outcomes of cryptococcosis in renal transplant recipients in a less‐resourced health care system
Author(s) -
Ponzio Vinicius,
Camargo Luis Fernando,
MedinaPestana José,
Perfect John Robert,
Colombo Arnaldo Lopes
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12910
Subject(s) - medicine , nephrotoxicity , cryptococcosis , amphotericin b , amphotericin b deoxycholate , concomitant , creatinine , transplantation , renal function , surgery , gastroenterology , urology , kidney , immunology , antifungal , caspofungin , dermatology
Background Cryptococcosis is the second most common cause of invasive fungal infections in renal transplant recipients in many countries, and data on graft outcome after treatment for this infection is lacking in less‐resourced health care settings. Methods Data from 47 renal transplant recipients were retrospectively collected at a single institution during a period of 13 years. Graft dysfunction, graft loss, and mortality rates were evaluated. Predictors of mortality and graft loss were estimated. Results A total of 38 (97.4%) patients treated with amphotericin B deoxycholate ( AMB d) showed graft dysfunction after antifungal initiation and 8 (18.2%) had kidney graft loss. Graft loss within 30 days after cryptococcosis onset was significantly associated with disseminated infection, greater baseline creatinine levels, and graft dysfunction concomitant to AMB d therapy and an additional nephrotoxic condition. The 30‐day mortality rate was 19.2% and it was significantly associated with disseminated and pulmonary infections, somnolence at admission, high CSF opening pressure, positive CSF India ink, creatinine levels greater than 2.0 mg/ dL at admission, graft dysfunction in patients treated with AMB d and an additional nephrotoxic condition and graft loss within 30 days. Conclusion Graft dysfunction was common in renal transplant recipients with cryptococcosis treated with AMB d. The rate of graft loss rate was high, most frequently in patients with concomitant nephrotoxic conditions. Therefore, the clinical focus should be on the use of less nephrotoxic lipid formulations of amphotericin B in this specific population requiring a polyene induction regimen for treatment of severe cryptococcosis in all health care systems caring for transplantation recipients.