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The Role Of Frequent Screening Or Diagnostic Testing Of Serum Cryptococcal Antigen In Liver Transplant Recipients: A Descriptive Epidemiology.

Home
Research Domains
Biomedical And Clinical Sciences
Oncology And Carcinogenesis
Predictive And Prognostic Markers
The Role Of Frequent Screening Or Diagnostic Testing Of Serum Cryptococcal Antigen In Liver Transplant Recipients: A Descriptive Epidemiology.

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The Role of Frequent Screening or Diagnostic Testing of Serum Cryptococcal Antigen in Liver Transplant Recipients: A Descriptive Epidemiology.

Toshiki Miwa¹, Koh Okamoto^1,2, Kazuhiko Ikeuchi¹

¹Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan.

Open Forum Infectious Diseases

|May 22, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Serum cryptococcal antigen (CrAg) screening aids early diagnosis of cryptococcosis in liver transplant recipients. However, routine screening in asymptomatic patients may offer limited value due to potential false positives.

Keywords:

asymptomatic cryptococcal antigenemia cryptococcal antigen cryptococcosis diagnostic stewardship

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Area of Science:

Infectious Diseases
Transplantation Medicine
Clinical Microbiology

Background:

Cryptococcosis is a significant infectious complication following liver transplantation.
Current guidelines lack recommendations for serum cryptococcal antigen (CrAg) screening in solid organ transplant recipients.
This study investigates the utility of serum CrAg testing in liver transplant recipients at an institution with established post-transplant CrAg testing protocols.

Purpose of the Study:

To evaluate the role and impact of serum CrAg testing in liver transplant recipients.
To assess the diagnostic performance of serum CrAg compared to culture for cryptococcosis.
To determine the clinical significance of positive serum CrAg results in both symptomatic and asymptomatic patients.

Main Methods:

liver transplant

Retrospective analysis of liver transplant recipients undergoing serum CrAg testing between April 2005 and March 2022.
Inclusion criteria: at least one post-transplant serum CrAg measurement.
Clinical data, management, and outcomes were reviewed for patients with positive CrAg tests or cultures.

Main Results:

12,885 serum CrAg tests were performed in 468 liver transplant recipients.
The 1-year incidence of positive serum CrAg and culture-proven cryptococcosis was 1.9% and 0.6%, respectively.
Serum CrAg was more sensitive than culture; early antifungal therapy was initiated in symptomatic patients based on positive CrAg results. Asymptomatic patients with negative CrAg did not develop cryptococcosis.

Conclusions:

Serum CrAg testing demonstrates higher sensitivity than culture for diagnosing cryptococcosis in liver transplant recipients.
Prompt antifungal therapy can be initiated in symptomatic patients guided by serum CrAg results.
Serial serum CrAg screening in asymptomatic liver transplant recipients may have limited clinical value and carries a risk of false-positive results.