Cryptococcosis in Patients With Cirrhosis of the Liver and Posttransplant Outcomes.

Abstract

BACKGROUND:

The outcomes and optimal management of cirrhotic patients who develop cryptococcosis before transplantation are not fully known.

METHODS:

We conducted a multicenter study involving consecutive patients with cirrhosis and cryptococcosis between January 2000 and March 2014. Data collected were generated as standard of care.

RESULTS:

In all, 112 patients were followed until death or up to 9 years. Disseminated disease and fungemia were present in 76.8% (86/112) and 90-day mortality was 57.1% (64/112). Of the 39 patients listed for transplant, 20.5% (8) underwent liver transplantation, including 2 with active but unrecognized disease before transplantation. Median duration of pretransplant antifungal therapy and posttransplant therapy was 43 days (interquartile range, 8-130 days) and 272 days (interquartile range, 180-630 days), respectively. Transplantation was associated with lower mortality (P = 0.002). None of the transplant recipients developed disease progression during the median follow-up of 3.5 years with a survival rate of 87.5%.

CONCLUSIONS:

Cryptococcosis in patients with cirrhosis has grave prognosis. Our findings suggest that transplantation after recent cryptococcal disease may not be a categorical exclusion and may be cautiously undertaken in liver transplant candidates who are otherwise deemed clinically stable.

• Authors: Nina Singh, Costi D Sifri, Fernanda P Silveira, Rachel Miller, Kevin S Gregg, Shirish Huprikar, Erika D Lease, Andrea Zimmer, J Stephen Dummer, Cedric W Spak, Christine Koval, David B Banach, Miloni Shroff, Jade Le, Darin Ostrander, Robin Avery, Albert Eid, Raymund R Razonable, Jose Montero, Emily Blumberg, Ahlaam Alynbiawi, Michele I Morris, Henry B Randall, George Alangaden, Jeffrey Tessier, Marilyn M Wagener, Hsin Yun Sun
• Journal: Transplantation (Transplantation) Vol. 99 Issue 10 Pg. 2132-41 (Oct 2015) ISSN: 1534-6080 [Electronic] United States
• PMID: 25806406 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Antifungal Agents
• Fluconazole

Topics

• Antifungal Agents (therapeutic use)
• Cryptococcosis (complications)
• Disease Progression
• Female
• Fluconazole (therapeutic use)
• Humans
• Liver (pathology)
• Liver Cirrhosis (complications, surgery)
• Liver Transplantation
• Male
• Middle Aged
• Prognosis
• Risk Factors
• Transplant Recipients
• Treatment Outcome