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Clin Infect Dis. 2015 Jan 1;60(1):36-44. doi: 10.1093/cid/ciu711. Epub 2014 Sep 9.

Predictors of immune reconstitution syndrome in organ transplant recipients with cryptococcosis: implications for the management of immunosuppression.

Author information

1
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
2
Duke University Medical Center, Durham, North Carolina.
3
Icahn School of Medicine at Mount Sinai, New York, New York.
4
University of Maryland School of Medicine, Baltimore.
5
Department of Internal Medicine, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
6
Department of Medicine, Emory University, Atlanta, Georgia.
7
Medical University of South Carolina, Charleston.
8
St John Medical Center, Detroit, Michigan.
9
Department of Medicine, University of Virginia, Charlottesville.
10
Department of Medicine, Mayo Clinic, Rochester, Minnesota.
11
Miller School of Medicine, University of Miami, Florida.
12
Department of Medicine, Northwestern University, Chicago, Illinois.
13
Department of Medicine, University of Pittsburgh, Pennsylvania.

Erratum in

Abstract

BACKGROUND:

Risk factors including how changes in immunosuppression influence the occurrence of immune reconstitution syndrome (IRS) in solid organ transplant (SOT) recipients with cryptococcosis have not been fully defined.

METHODS:

SOT recipients with cryptococcosis were identified and followed for 12 months. IRS was defined based on previously proposed criteria.

RESULTS:

Of 89 SOT recipients, 13 (14%) developed IRS. Central nervous system (CNS) disease (adjusted odds ratio [AOR], 6.23; P = .03) and discontinuation of calcineurin inhibitor (AOR, 5.11; P = .02) were independently associated with IRS. Only 2.6% (1/13) of the patients without these risk factors developed IRS compared with 18.8% (6/32) with 1 risk factor, and 50% (6/12) with both risk factors (χ(2) for trend, P = .0001). Among patients with CNS disease, those with neuroimaging abnormalities (P = .03) were more likely to develop IRS, irrespective of serum or CSF cryptococcal antigen titers and fungemia. Graft rejection after cryptococcosis was observed in 15.4% (2/13) of the patients with IRS compared with 2.6% (2/76) of those without IRS (P = .07).

CONCLUSIONS:

We determined variables that pose a risk for IRS and have shown that discontinuation of calcineurin inhibitors was independently associated with 5-fold increased risk of IRS in transplant recipients with cryptococcosis.

KEYWORDS:

Cryptococcus; fungal infections; immunosuppression; transplant

PMID:
25210020
PMCID:
PMC6283360
DOI:
10.1093/cid/ciu711
[Indexed for MEDLINE]
Free PMC Article

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