Infectious Disease

Wednesday September 16, 2020 from

Room: E-Poster Hall

P-9.23 Clinical characteristics and long-term outcomes of cryptococcosis in solid organ transplant recipients

Pakpoom Phoompoung, Thailand

Division of infectious disease and tropical medicine
Faculty of Medicine Siriraj Hospital

Abstract

Clinical characteristics and long-term outcomes of cryptococcosis in solid organ transplant recipients

Pakpoom Phoompoung1,2, Shahid Husain2.

1Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand; 2Multi-organ Transplant Program, University Health Network, Toronto, ON, Canada

Background: Cryptococcosis causes significant morbidity and mortality in solid organ transplant (SOT) recipients. However, data regarding clinical characteristics and long-term outcomes of cryptococcosis in this population remain scarce.
Methods: We performed a single-center, retrospective study including all adult SOT recipients who were diagnosed with cryptococcosis during the study period of January 1, 2008 to December 31, 2017. Cryptococcosis was diagnosed according to EORTC/MSG revised criteria.
Results and Discussion: Thirteen patients were included in the study. There were 8 men (61.5%) and median age was 63-year-old (range 41-78). Study population included 5 kidney, 4 lung, 3 liver and 1 heart-lung transplant recipients. Median onset of the disease was 18 months after transplant (1 week to 8 years). Four patients (30.8%) had isolated pulmonary cryptococcosis and six patients (46.2%) had more than one organ involvement. Among 6 patients who had positive cerebrospinal fluid (CSF) culture, two-third had lymphocytic pleocytosis. High CSF protein level and low surgar level were noticed in 83% and 17%, respectively. CSF cryptococcal antigen was positive in only half of these patients, while serum cryptococcal antigen was detected in all patients. Most patients received liposomal amphotericin B with or without flucytosine as induction therapy, followed by fluconazole as consolidation and maintenance treatment.  Immune reconstitution inflammatory syndrome (IRIS) occurred in 2 patients, which resulted in one death. Both of them had disseminated diseases. One had IRIS during consolidation therapy, while one patient who received 7 months of antifungal therapy, developed IRIS 2 months after treatment discontinuation.  Overall 1-year survival rate was 69.2%. All patients (2/2) who had very early onset disease (<1 month) died from cryptococcosis. Overall 1-year graft survival rate was 84.6%.
Conclusion: Cryptococcosis after SOT  occurred late after transplant. It was associated with poor survival. Higher fungal associated mortality rate is associated with very early onset of disease and immune reconstitution syndrome.

Comments

There are no comments yet...



© 2024 TTS 2020