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Published on: April 13, 2021
Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France
Laurène Tardieu1, Gillian Divard2,3, Olivier Lortholary4,5
1Service de Soins Intensifs Néphrologiques et Rein Aigu, French Intensive Renal Network, Hôpital Tenon, 75020 Paris, France.
Abstract:
Cryptococcosis is the third most common cause of invasive fungal infection in solid organ transplant recipients and cryptococcal meningitis (CM) its main clinical presentation. CM outcomes, as well as its clinical features and radiological characteristics, have not yet been considered on a large scale in the context of kidney transplantation (KT). We performed a nationwide retrospective study of adult patients diagnosed with cryptococcosis after KT between 2002 and 2020 across 30 clinical centers in France. We sought to describe overall and graft survival based on whether KT patients with cryptococcosis developed CM or not. Clinical indicators of CNS involvement and brain radiological characteristics were assessed. Eighty-eight cases of cryptococcosis were diagnosed during the study period, with 61 (69.3%) cases of CM. Mortality was high (32.8%) at 12 months (M12) but not significantly different whether or not patients presented with CM. Baseline hyponatremia and at least one neurological symptom were independently associated with CM (p < 0.001). Positive serum cryptococcal antigen at diagnosis was also significantly associated with CM (p < 0.001). On magnetic resonance imaging (MRI), three patterns of brain injury were identified: parenchymal, meningeal, and vascular lesions. Although CM does not affect graft function directly, it entails a grim prognosis.
Insights
Cryptococcosis, a fungal infection, is common in kidney transplant recipients. Cryptococcal meningitis (CM) presents a high mortality risk, with neurological symptoms and hyponatremia indicating CNS involvement.
Area of Science:
- Infectious Diseases
- Nephrology
- Neurology
Background:
- Cryptococcosis is a significant invasive fungal infection in solid organ transplant recipients.
- Cryptococcal meningitis (CM) is the primary clinical manifestation.
- Large-scale data on CM in kidney transplant (KT) recipients are limited.
Purpose of the Study:
- To analyze outcomes, clinical features, and radiological characteristics of cryptococcosis in KT patients.
- To compare graft and overall survival in KT patients with and without CM.
- To identify predictors of central nervous system (CNS) involvement in KT patients with cryptococcosis.
Main Methods:
- Nationwide retrospective study of adult KT patients diagnosed with cryptococcosis (2002-2020).
- Data collected from 30 French clinical centers.
- Assessment of clinical indicators, neurological symptoms, and brain MRI findings.
Main Results:
- Eighty-eight cases of cryptococcosis, 61 (69.3%) with CM.
- 12-month mortality was 32.8%, not significantly different between CM and non-CM groups.
- Hyponatremia, neurological symptoms, and positive serum cryptococcal antigen predicted CM.
- MRI revealed parenchymal, meningeal, and vascular brain injury patterns.
Conclusions:
- CM in KT recipients is associated with high mortality, despite not directly impacting graft function.
- Early identification of neurological symptoms and specific biomarkers is crucial for CM diagnosis.
- Understanding radiological patterns aids in managing cryptococcosis post-kidney transplantation.
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