Cryptococcal meningitis: an analysis among 5521 consecutive organ transplant recipients

Authors

  • G. Wu,

    1. Department of Neurology,
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    • These authors contributed equally to this work.

  • R.A. Vilchez,

    1. Department of Medicine,University of Pittsburgh Medical Center,
    2. Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania,
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    • *Presented in part at the Annual Meeting of the American Academy of Neurology held in San Diego from April 29 to May 6, 2000 (abstract #P04.058).

    • These authors contributed equally to this work.

  • B. Eidelman,

    1. Department of Neurology,
    2. Department of Medicine,University of Pittsburgh Medical Center,
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  • J. Fung,

    1. Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania,
    2. Department of Surgery,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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  • R. Kormos,

    1. Department of Surgery,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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  • S. Kusne

    Corresponding author
    1. Department of Neurology,
    2. Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania,
    3. Department of Surgery,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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  • *

    Regis A. Vilchez, MD is the recipient of the Junior Faculty Development Award from GlaxoSmithKline. He is currently affiliated with the Department of Medicine, and Molecular virology and Microbiology, Baylor College of Medicine, Houston, Texas.

Shimon Kusne, MD
University of Pittsburgh  Medical Center
Division of Infectious  Diseases
Falk Medical Building Suite 3A
3601 Fifth Avenue
Pittsburgh,
PA 15213
USA
Tel: (412) 648-6401
Fax: (412) 648-6399
e-mail: kusnes2@msx.upmc.edu

Abstract

Abstract: Cryptococcal meningitis has been reported to be an important cause of morbidity and mortality in renal transplant recipients. However, additional studies of recipients of other organ transplants suggested that these patients might be at low risk for cryptococcal meningitis. We examined the incidence and clinical features of cryptococcal meningitis among different groups of organ transplant patients at the University of Pittsburgh Medical Center. From January 1989 through July 1999, 28 patients were diagnosed with cryptococcal meningitis among 5521 transplant recipients. These included liver (11/2539), heart (8/372), kidney (7/2122), lung (1/432), and small bowel (1/56) recipients. The incidence of cryptococcal meningitis was higher in heart and small bowel recipients compared to other transplant populations (P = 0.005). The cryptococcal meningitis-related mortality in transplant recipients was 50% and was associated with altered mental status (P = 0.001), absence of headache (P = 0.02), and liver failure (P = 0.002). Multivariable analysis indicated that liver failure was the only independent risk factor for poor prognosis (P = 0.043). All cases of liver failure occurred among liver transplant recipients. Cryptococcal meningitis is associated with significant mortality among organ transplant recipients. The presence of allograft failure in liver transplant recipients with cryptococcal meningitis may be an indicator of poor prognosis in this patient population.

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