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Outcomes of cryptococcosis in renal transplant recipients in a less-resourced health care system.

Publication ,  Journal Article
Ponzio, V; Camargo, LF; Medina-Pestana, J; Perfect, JR; Colombo, AL
Published in: Transpl Infect Dis
August 2018

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 (AMBd) 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 AMBd 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 AMBd and an additional nephrotoxic condition and graft loss within 30 days. CONCLUSION: Graft dysfunction was common in renal transplant recipients with cryptococcosis treated with AMBd. 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.

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Published In

Transpl Infect Dis

DOI

EISSN

1399-3062

Publication Date

August 2018

Volume

20

Issue

4

Start / End Page

e12910

Location

Denmark

Related Subject Headings

  • Young Adult
  • Transplant Recipients
  • Surgery
  • Retrospective Studies
  • Middle Aged
  • Male
  • Kidney Transplantation
  • Kidney
  • Invasive Fungal Infections
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Ponzio, V., Camargo, L. F., Medina-Pestana, J., Perfect, J. R., & Colombo, A. L. (2018). Outcomes of cryptococcosis in renal transplant recipients in a less-resourced health care system. Transpl Infect Dis, 20(4), e12910. https://doi.org/10.1111/tid.12910
Ponzio, Vinicius, Luis Fernando Camargo, José Medina-Pestana, John Robert Perfect, and Arnaldo Lopes Colombo. “Outcomes of cryptococcosis in renal transplant recipients in a less-resourced health care system.Transpl Infect Dis 20, no. 4 (August 2018): e12910. https://doi.org/10.1111/tid.12910.
Ponzio V, Camargo LF, Medina-Pestana J, Perfect JR, Colombo AL. Outcomes of cryptococcosis in renal transplant recipients in a less-resourced health care system. Transpl Infect Dis. 2018 Aug;20(4):e12910.
Ponzio, Vinicius, et al. “Outcomes of cryptococcosis in renal transplant recipients in a less-resourced health care system.Transpl Infect Dis, vol. 20, no. 4, Aug. 2018, p. e12910. Pubmed, doi:10.1111/tid.12910.
Ponzio V, Camargo LF, Medina-Pestana J, Perfect JR, Colombo AL. Outcomes of cryptococcosis in renal transplant recipients in a less-resourced health care system. Transpl Infect Dis. 2018 Aug;20(4):e12910.
Journal cover image

Published In

Transpl Infect Dis

DOI

EISSN

1399-3062

Publication Date

August 2018

Volume

20

Issue

4

Start / End Page

e12910

Location

Denmark

Related Subject Headings

  • Young Adult
  • Transplant Recipients
  • Surgery
  • Retrospective Studies
  • Middle Aged
  • Male
  • Kidney Transplantation
  • Kidney
  • Invasive Fungal Infections
  • Humans