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Observational Study
. 2015 Jan 1;60(1):36-44.
doi: 10.1093/cid/ciu711. Epub 2014 Sep 9.

Predictors of immune reconstitution syndrome in organ transplant recipients with cryptococcosis: implications for the management of immunosuppression

Hsin-Yun Sun  1 , Barbara D Alexander  2 , Shirish Huprikar  3 , Graeme N Forrest  4 , Didier Bruno  5 , G Marshall Lyon  6 , Dannah Wray  7 , Leonard B Johnson  8 , Costi D Sifri  9 , Raymund R Razonable  10 , Michele I Morris  11 , Valentina Stosor  12 , Marilyn M Wagener  13 , Nina Singh  13
Affiliations
Observational Study

Predictors of immune reconstitution syndrome in organ transplant recipients with cryptococcosis: implications for the management of immunosuppression

Hsin-Yun Sun et al. Clin Infect Dis. .

Erratum in

  • Sun HY, et al (Clin Infect Dis 2015; 60:36-44).
    [No authors listed] [No authors listed] Clin Infect Dis. 2016 Jun 15;62(12):1621. doi: 10.1093/cid/ciw246. Epub 2016 Apr 28. Clin Infect Dis. 2016. PMID: 27126347 Free PMC article. No abstract available.

Abstract

Background: Risk factors including how changes in immunosuppression influence the occurrence of immune reconstitution syndrome (IRS) in solid organ transplant (SOT) recipients with cryptococcosis have not been fully defined.

Methods: SOT recipients with cryptococcosis were identified and followed for 12 months. IRS was defined based on previously proposed criteria.

Results: Of 89 SOT recipients, 13 (14%) developed IRS. Central nervous system (CNS) disease (adjusted odds ratio [AOR], 6.23; P = .03) and discontinuation of calcineurin inhibitor (AOR, 5.11; P = .02) were independently associated with IRS. Only 2.6% (1/13) of the patients without these risk factors developed IRS compared with 18.8% (6/32) with 1 risk factor, and 50% (6/12) with both risk factors (χ(2) for trend, P = .0001). Among patients with CNS disease, those with neuroimaging abnormalities (P = .03) were more likely to develop IRS, irrespective of serum or CSF cryptococcal antigen titers and fungemia. Graft rejection after cryptococcosis was observed in 15.4% (2/13) of the patients with IRS compared with 2.6% (2/76) of those without IRS (P = .07).

Conclusions: We determined variables that pose a risk for IRS and have shown that discontinuation of calcineurin inhibitors was independently associated with 5-fold increased risk of IRS in transplant recipients with cryptococcosis.

Keywords: Cryptococcus; fungal infections; immunosuppression; transplant.

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References

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