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Cryptococcal meningitis after liver transplantation

N Jabbour1, J Reyes, S Kusne

  • 1University of Pittsburgh, Pittsburgh Transplantation Institute, Pennsylvania 15213, USA.

Transplantation
|January 15, 1996
PubMed
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Cryptococcal meningitis is a rare but serious complication in liver transplant recipients. Early diagnosis and combination antifungal treatment with reduced immunosuppression are crucial for survival.

Area of Science:

  • Infectious Diseases
  • Transplantation Medicine
  • Neurology

Background:

  • Liver transplant recipients are immunocompromised, increasing susceptibility to opportunistic infections.
  • Cryptococcal meningitis is a significant cause of morbidity and mortality in this population.

Purpose of the Study:

  • To describe the clinical experience with cryptococcal meningitis in liver transplant recipients.
  • To evaluate treatment outcomes and identify factors influencing survival.

Main Methods:

  • Retrospective case series of 10 liver transplant recipients diagnosed with cryptococcal meningitis.
  • Analysis of clinical presentation, diagnostic methods, treatment regimens (amphotericin B and flucytosine), and outcomes.

Main Results:

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  • Cryptococcal meningitis occurred a median of 3.5 months post-transplant.
  • Headache, fever, and altered mental status were common; meningismus was infrequent.
  • Cerebrospinal fluid analysis was diagnostic in all cases.
  • The mortality rate was 50%, with 4 deaths directly from infection.
  • Long-term sequelae included blindness in one survivor.

Conclusions:

  • Cryptococcal meningitis is a rare (0.25%) but highly fatal complication in liver transplant recipients.
  • Early recognition, prompt combination antifungal therapy, and immunosuppression adjustment are vital for successful management.
  • No relapses were observed in surviving patients.