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Cryptococcosis in Patients With Cirrhosis of the Liver and Posttransplant Outcomes
Nina Singh1, Costi D Sifri, Fernanda P Silveira
11 Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA. 2 University of Virginia, Charlottesville, VA. 3 University of Iowa, Iowa City, IA. 4 University of Michigan, Ann Arbor, MI. 5 Icahn School of Medicine at Mount Sinai, New York, NY. 6 University of Washington, Seattle, WA. 7 Vanderbilt University, Nashville, TN. 8 Baylor Health System, Dallas, TX. 9 Cleveland Clinic, Cleveland, OH. 10 Yale School of Medicine, New Haven, CT. 11 University of Texas Southwestern Medical Center, Dallas, TX. 12 Johns Hopkins University, Baltimore, MD. 13 University of Kansas, Kansas City, KS. 14 Mayo Clinic, Rochester, MN. 15 University of South Florida, Tampa, FL. 16 University of Pennsylvania, Philadelphia, PA. 17 University of Miami, Miller School of Medicine, Miami, FL. 18 Department of Surgery, St. Luke's Hospital, Kansas City, MO. 19 Henry Ford Hospital, Detroit, MI. 20 Virginia Commonwealth University, Richmond, VA. 21 Department of Internal Medicine, National Taiwan University Hospital and National, Taipei, Taiwan.
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.
