Unrecognized pretransplant and donor‐derived cryptococcal disease in organ transplant recipients.
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‐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 articleSubject
AdultAged
Cohort Studies
Cryptococcosis
Cryptococcus
Female
Humans
Male
Middle Aged
Postoperative Complications
Time Factors
Tissue Donors
Transplants
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https://hdl.handle.net/10161/4161Published Version (Please cite this version)
10.1086/656584Publication 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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Show full item recordScholars@Duke
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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