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Unrecognized pretransplant and donor‐derived cryptococcal disease in organ transplant recipients.

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Date
2010-11-01
Authors
Sun, HY
Alexander, BD
Lortholary, O
Dromer, F
Forrest, GN
Lyon, GM
Somani, J
Gupta, KL
Busto, R del
Pruett, TL
Sifri, CD
Limaye, AP
John, GT
Klintmalm, GB
Pursell, K
Stosor, V
Morris, MI
Dowdy, LA
Munoz, P
Kalil, AC
Garcia-Diaz, J
Orloff, SL
House, AA
Houston, SH
Wray, D
Huprikar, S
Johnson, LB
Humar, A
Razonable, RR
Fisher, RA
Husain, S
Wagener, MM
Singh, N
Group, Cryptococcal Collaborative Transplant Study
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Abstract
BACKGROUND: Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known. METHODS: Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days after transplantation, respectively. RESULTS: Very early-onset disease developed in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6% (5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcus isolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor&#x2010;acquired infection. CONCLUSIONS: A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.
Type
Journal article
Subject
Adult
Aged
Cohort Studies
Cryptococcosis
Cryptococcus
Female
Humans
Male
Middle Aged
Postoperative Complications
Time Factors
Tissue Donors
Transplants
Permalink
https://hdl.handle.net/10161/4161
Published Version (Please cite this version)
10.1086/656584
Publication Info
Sun, HY; Alexander, BD; Lortholary, O; Dromer, F; Forrest, GN; Lyon, GM; ... Group, Cryptococcal Collaborative Transplant Study (2010). Unrecognized pretransplant and donor‐derived cryptococcal disease in organ transplant recipients. Clin Infect Dis, 51(9). pp. 1062-1069. 10.1086/656584. Retrieved from https://hdl.handle.net/10161/4161.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Alexander

Barbara Dudley Alexander

Professor of Medicine
Clinical research related to infectious complications of solid organ and bone marrow transplantation, with a particular interest in the treatment and rapid diagnosis of fungal disease. Training the next generation of Transplant Infectious Disease Physicians is a special focus of mine as the Principal Investigator of our Interdisciplinary T32 Training Program funded the NIH. 
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