Cryptococcosis in Patients With Cirrhosis of the Liver and Posttransplant Outcomes. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Singh, Nina; Sifri, Costi D.; Silveira, Fernanda P.; Miller, Rachel; Gregg, Kevin S.; Huprikar, Shirish; Lease, Erika D.; Zimmer, Andrea; Dummer, J. Stephen; Spak, Cedric W.; Koval, Christine; Banach, David B.; Shroff, Miloni; Le, Jade; Ostrander, Darin; Avery, Robin; Eid, Albert; Razonable, Raymund R.; Montero, Jose; Blumberg, Emily; Alynbiawi, Ahlaam; Morris, Michele I.; Randall, Henry B.; Alangaden, George; Tessier, Jeffrey; Wagener, Marilyn M.; Sun, Hsin Yun
• Is Part Of: Transplantation. Volume 99:Issue 10(2015)
• Publication Date: 2015-10
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000000690
• Languages: English
• ISSNs: 0041-1337

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background</title> <p>The outcomes and optimal management of cirrhotic patients who develop cryptococcosis before transplantation are not fully known.</p> </sec> <sec> <title>Methods</title> <p>We conducted a multicenter study involving consecutive patients with cirrhosis and cryptococcosis between January 2000 and March 2014. Data collected were generated as standard of care.</p> </sec> <sec> <title>Results</title> <p>In all, 112 patients were followed until death or up to 9 years. Disseminated disease and fungemia were present in 76.8% (86/112) and 90-day mortality was 57.1% (64/112). Of the 39 patients listed for transplant, 20.5% (8) underwent liver transplantation, including 2 with active but unrecognized disease before transplantation. Median duration of pretransplant antifungal therapy and posttransplant therapy was 43 days (interquartile range, 8-130 days) and 272 days (interquartile range, 180-630 days), respectively. Transplantation was associated with lower mortality (<italic>P</italic> = 0.002). None of the transplant recipients developed disease progression during the median follow-up of 3.5 years with a survival rate of 87.5%.</p> </sec> <sec> <title>Conclusions</title> <p>Cryptococcosis in patients with cirrhosis has grave prognosis. Our findings suggest that transplantation after recent cryptococcal disease may not be a categorical exclusion and may be cautiously undertaken in liver transplant candidates who are otherwise deemed clinically stable.</p> </sec> </abstract>