A retrospective study of cryptococcal infection after renal transplantation and literature review
10.3760/cma.j.cn421203-20200108-00007
- VernacularTitle:肾移植受者术后隐球菌感染的回顾性分析及文献复习
- Author:
Xueyang ZHENG
1
;
Jiyuan WANG
;
Yue DING
;
Yu CHEN
;
Fanyuan ZHU
;
Shangxi FU
;
Shu HAN
Author Information
1. 海军军医大学第二附属医院解放军器官移植研究所，上海 200003
- From:
Chinese Journal of Organ Transplantation
2020;41(4):221-226
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical characteristics, diagnosis and treatment of cryptococcal infection after renal transplantation.Methods:The clinical data were analyzed retrospectively for 17 hospitalized cases of cryptococcal infection after kidney transplantation from January 2003 to December 2019. The relevant parameters included site of infection, clinical manifestations, complications, comorbidities, treatments and outcomes. The average time to infection after transplantation was (7.9±5.4) years, the median baseline level of creatinine was 137(75-741) μmol/L. Concurrent conditions included hypertension (n=15, 88.2%), diabetes (n=6, 35.3%) and chronic hepatitis (n=9, 52.9%). The most common site of infection was central nervous system (88.2%), followed by lungs (29.4%) and skin (17.6%).Results:The clinical manifestations were diverse. Most patients received amphotericin B liposome and/or fluconazole as an initial option. The outcomes were curing (n=17, 58.8%), death from cryptococcal infection (n=5, 29.4%), partial relief (n=1, 5.9%) and stable disease (n=1, 5.9%). Among 10 curative cases, 2 cases died from other causes and 4 cases returned to hemodialysis with graft loss.Conclusions:Cryptococcosis is typically a late-occurring infection in kidney transplant recipients. Many factors, such as complications, nonstandard antifungal treatment, immune dysbalance, have adverse prognoses. Strengthening follow-ups, dealing with complications, validating the diagnosis early, interdepartmental cooperations, standardizing antifungal therapy and balancing immune status may improve the outcomes of cryptococcosis after kidney transplantation.
