P-2134. Cryptococcosis in kidney transplant recipients: a single centre experience

TL;DR

This study examines cryptococcosis in kidney transplant patients, finding that disseminated disease has the highest mortality and highlighting the importance of early detection.

Contribution

The study provides a detailed analysis of clinical manifestations and outcomes of cryptococcosis in a single-center kidney transplant cohort.

Findings

Disseminated cryptococcosis had the highest mortality rate (22.2%) within six months.

Clinical presentations varied, with fever and headache being the most common symptoms.

Amphotericin B plus flucytosine was the preferred treatment for severe cases.

Abstract

Kidney transplant (KT) recipients have the lowest risk of Cryptococcosis among the solid organ transplant population, although this infection carries significant morbidity and mortality.Demographic characteristics of Cryptococcosis in kidney transplant recipientsDistribution of Cryptococcosis clinical presentation among KT recipients

Demographic characteristics of Cryptococcosis in kidney transplant recipients

Distribution of Cryptococcosis clinical presentation among KT recipients

Retrospective historical cohort in a single center in Medellin Colombia to analyse C. neoformans cryptococcosis in KT recipients from 2011 to 2024. Statistical analysis included chi-square tests for categorical variables, Kruskal-Wallis for continuous variables, and Kaplan-Meier survival analysis with log-rank tests.Kaplan-Meier Curve of cumulative % disease-free over time (years) in different forms of cryptococcosis in KT recipients

Kaplan-Meier Curve of cumulative % disease-free over time (years) in different forms of cryptococcosis in KT recipients

Twenty cases of cryptococcosis were diagnosed during the study period. Demographic data among KT recipients with isolated pulmonary cryptococcosis, isolated meningitis, and disseminated cryptococcosis showed comparable median ages (54, 46, and 58 years, respectively; p = 0.165), with male predominance in the meningitis and disseminated groups (75 and 55.5% respectively, p = 0.006). Median time from KT to infection was 4.03 years (IQR 2.2-6.7) and median time from rejection to cryptococcosis was 1.52 years (IQR 0.8-2.3). The most common clinical manifestations at diagnosis were: fever (28.5–5.5%, p < 0.001), headache (100% in meningitis/disseminated, p < 0.001), and respiratory symptoms mainly in pulmonary cases. Increasing positivity for serum Cryptococcal antigen from pulmonary cases (57.1%) to disseminated cases (88.8%, p < 0.001). Cerebrospinal fluid analysis showed mild pleocytosis (14 cells/µL) and hyperproteinorrachia in meningitis/disseminated cases. Chest CT revealed distinct radiological patterns, with solid nodules in pulmonary (57.1%) and disseminated (33.3%) disease. Amphotericin B plus flucytosine was the therapy of choice in meningitis/disseminated disease, whereas fluconazole was used primarily for mild pulmonary disease, followed by fluconazole maintenance therapy. Six-month deaths occurred exclusively in disseminated cases (22.2%, p < 0.001) and disease-free survival showed no significant difference between groups (p = 0.38).

In KT recipients, the clinical manifestations of Cryptococcosis are varied. Although disease-free survival was similar between groups, disseminated disease carries the highest risk of death, highlighting early detection and targeted therapy to achieve the best outcome.

All Authors: No reported disclosures

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