Cryptococcus neoformans in organ transplant recipients: Impact of calcineurin-inhibitor agents on mortality

Singh, Nina, Alexander, Barbara D., Lortholary, Olivier, Dromer, Francoise, Gupta, Krishan L., John, George T., del Busto, Ramon, Klintmalm, Goran B., Somani, Jyoti, Lyon, G. Marshall, Pursell, Kenneth, Stosor, Valentina, Munoz, Patricia, Limaye, Ajit P., Kalil, Andre C., Pruett, Timothy L., Garcia-Diaz, Julia, Humar, Atul, Houston, Sally, House, Andrew A., Wray, Dannah, Orloff, Susan, Dowdy, Lorraine A., Fisher, Robert A., Heitman, Joseph, Wagener, Marilyn M., Husain, Shahid and Cryptococcal Collaborative Transpl (2007) Cryptococcus neoformans in organ transplant recipients: Impact of calcineurin-inhibitor agents on mortality. Journal of Infectious Diseases, 195 5: 756-764. doi:10.1086/511438


Author Singh, Nina
Alexander, Barbara D.
Lortholary, Olivier
Dromer, Francoise
Gupta, Krishan L.
John, George T.
del Busto, Ramon
Klintmalm, Goran B.
Somani, Jyoti
Lyon, G. Marshall
Pursell, Kenneth
Stosor, Valentina
Munoz, Patricia
Limaye, Ajit P.
Kalil, Andre C.
Pruett, Timothy L.
Garcia-Diaz, Julia
Humar, Atul
Houston, Sally
House, Andrew A.
Wray, Dannah
Orloff, Susan
Dowdy, Lorraine A.
Fisher, Robert A.
Heitman, Joseph
Wagener, Marilyn M.
Husain, Shahid
Cryptococcal Collaborative Transpl
Title Cryptococcus neoformans in organ transplant recipients: Impact of calcineurin-inhibitor agents on mortality
Formatted title
Cryptococcus neoformans in organ transplant recipients: Impact of calcineurin-inhibitor agents on mortality
Journal name Journal of Infectious Diseases   Check publisher's open access policy
ISSN 0022-1899
1537-6613
Publication date 2007-03-01
Sub-type Article (original research)
DOI 10.1086/511438
Volume 195
Issue 5
Start page 756
End page 764
Total pages 9
Place of publication Cary, NC, United States
Publisher Oxford University Press
Language eng
Formatted abstract
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. Sixtyone 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 calcineurin-inhibitor agent (P=.003). In amultivariable 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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
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