Predictors of immune reconstitution syndrome in organ transplant recipients with cryptococcosis: Implications for the management of immunosuppression
Journal
Clinical Infectious Diseases
Journal Volume
60
Journal Issue
1
Pages
36-44
Date Issued
2015
Author(s)
Alexander B.D.
Huprikar S.
Forrest G.N.
Bruno D.
Lyon G.M.
Wray D.
Johnson L.B.
Sifri C.D.
Razonable R.R.
Morris M.I.
Stoser V.
Wagener M.M.
Singh N.
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 (X2 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. ? The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
SDGs
Other Subjects
antifungal agent; azathioprine; creatinine; cyclosporin A; fungus antigen; mycophenolate mofetil; prednisone; rapamycin; tacrolimus; calcineurin inhibitor; adult; antifungal therapy; Article; cardiac graft rejection; central nervous system disease; cerebrospinal fluid; cerebrospinal fluid flow; controlled clinical trial; controlled study; creatinine blood level; cryptococcosis; female; follow up; fungemia; graft recipient; graft rejection; heart graft; human; immune reconstitution inflammatory syndrome; immunosuppressive treatment; kidney graft; kidney graft rejection; kidney pancreas transplantation; liver graft; liver graft rejection; lung graft rejection; lung transplantation; major clinical study; male; neuroimaging; observational study; pancreas transplantation; priority journal; risk factor; serum bactericidal antibody assay; adverse effects; aged; complication; cryptococcosis; immune reconstitution inflammatory syndrome; immunosuppressive treatment; middle aged; organ transplantation; prevalence; procedures; Aged; Calcineurin Inhibitors; Cryptococcosis; Female; Humans; Immune Reconstitution Inflammatory Syndrome; Immunosuppression; Male; Middle Aged; Organ Transplantation; Prevalence; Risk Factors; Transplant Recipients
Publisher
Oxford University Press
Type
journal article