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Cryptococcus neoformans in Organ Transplant Recipients: Impact of Calcineurin-Inhibitor Agents on Mortality

Singh, Nina ; Alexander, Barbara D. ; Lortholary, Olivier ; Dromer, Françoise ; Gupta, Krishan L. ; John, George T. ; del Busto, Ramon ; Klintmalm, Goran B. ; Somani, Jyoti ; Lyon, G. Marshall ; Pursell, Kenneth ; Stosor, Valentina ; Muñoz, Patricia ; Limaye, Ajit P. ; Kalil, Andre C. ; Pruett, Timothy L. ; Garcia-Diaz, Julia ; Humar, Atul ; Houston, Sally ; House, Andrew A. ; Wray, Dannah ; Orloff, Susan ; Dowdy, Lorraine A. ; Fisher, Robert A. ; Heitman, Joseph ; Wagener, Marilyn M. ; Husain, Shahid

The Journal of infectious diseases, 2007-03, Vol.195 (5), p.756-764 [Periódico revisado por pares]

Chicago, IL: The University of Chicago Press

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Título:
Cryptococcus neoformans in Organ Transplant Recipients: Impact of Calcineurin-Inhibitor Agents on Mortality
Autor: Singh, Nina ; Alexander, Barbara D. ; Lortholary, Olivier ; Dromer, Françoise ; Gupta, Krishan L. ; John, George T. ; del Busto, Ramon ; Klintmalm, Goran B. ; Somani, Jyoti ; Lyon, G. Marshall ; Pursell, Kenneth ; Stosor, Valentina ; Muñoz, Patricia ; Limaye, Ajit P. ; Kalil, Andre C. ; Pruett, Timothy L. ; Garcia-Diaz, Julia ; Humar, Atul ; Houston, Sally ; House, Andrew A. ; Wray, Dannah ; Orloff, Susan ; Dowdy, Lorraine A. ; Fisher, Robert A. ; Heitman, Joseph ; Wagener, Marilyn M. ; Husain, Shahid
Assuntos: Adult ; Aged ; Antifungals ; Biological and medical sciences ; Calcineurin Inhibitors ; Cryptococcosis ; Cryptococcosis - microbiology ; Cryptococcosis - mortality ; Cryptococcus neoformans ; Cryptococcus neoformans - drug effects ; Female ; Fundamental and applied biological sciences. Psychology ; Fungal infections ; Fungi ; Humans ; Immunosuppressants ; Immunosuppressive Agents - pharmacology ; Infections ; Infectious diseases ; Kidney failure ; Liver ; Male ; Medical sciences ; Microbiology ; Middle Aged ; Miscellaneous ; Mortality ; Mycology ; Organ Transplantation ; Transplantation ; Treatment Outcome
É parte de: The Journal of infectious diseases, 2007-03, Vol.195 (5), p.756-764
Notas: Study group members are listed after the text.
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Descrição: Variables influencing the risk of dissemination and outcome of Cryptococcus neoformans infection were assessed in 111 organ transplant recipients with cryptococcosis in a prospective, multicenter, international study. Sixtyone percent (68/111) of the patients had disseminated infection. The risk of disseminated cryptococcosis was significantly higher for liver transplant recipients (adjusted hazard ratio [HR], 6.65; P=.048). The overall mortality rate at 90 days was 14% (16/111). The mortality rate was higher in patients with abnormal mental status (P=.023), renal failure at baseline (P=.028), fungemia (P=.006), and disseminated infection (P=.035) and was lower in those receiving a calcineurin-inhibitor agent (P=.003). In amultivariable analysis, the receipt of a calcineurin-inhibitor agent was independently associated with a lower mortality (adjusted HR, 0.21; P=.008), and renal failure at baseline with a higher mortality rate (adjusted HR, 3.14; P=.037). Thus, outcome in transplant recipients with cryptococcosis appears to be influenced by the type of immunosuppressive agent employed. Additionally, discerning the basis for transplant type-specific differences in disease severity has implications relevant for yielding further insights into the pathogenesis of C. neoformans infection in transplant recipients.
Editor: Chicago, IL: The University of Chicago Press
Idioma: Inglês

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Cryptococcus neoformans in Organ Transplant Recipients: Impact of Calcineurin-Inhibitor Agents on Mortality

Chicago, IL: The University of Chicago Press

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