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. 2022 Jun 17;11(6):699.
doi: 10.3390/pathogens11060699.

Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France

Laurène Tardieu  1 , Gillian Divard  2   3 , Olivier Lortholary  4   5 , Anne Scemla  3 , Éric Rondeau  1 , Isabelle Accoceberry  6 , Rémi Agbonon  7 , Alexandre Alanio  8 , Adela Angoulvant  9 , Laetitia Albano  10 , Philippe Attias  11 , Anne Pauline Bellanger  12 , Dominique Bertrand  13 , Julie Bonhomme  14 , Françoise Botterel  15 , Nicolas Bouvier  16 , Matthias Buchler  17 , Taieb Chouaki  18 , Thomas Crépin  19 , Marie-Fleur Durieux  20 , Guillaume Desoubeaux  21 , Gary Doppelt  22 , Loïc Favennec  23 , Arnaud Fekkar  24 , Ophélie Fourdinier  25 , Marie Frimat  26 , Jean-Pierre Gangneux  27 , Claire Garandeau  28 , Lilia Hasseine  29 , Christophe Hennequin  30 , Xavier Iriart  31 , Nassim Kamar  32 , Hannah Kaminski  33 , Raphael Kormann  34 , Laurence Lachaud  35 , Christophe Legendre  36 , Moglie Le Quintrec Donnette  37 , Jordan Leroy  38   39 , Charlène Levi  40 , Marie Machouart  41 , David Marx  42 , Jean Menotti  43 , Valérie Moal  44 , Florent Morio  45 , Natacha Mrozek  46 , Muriel Nicolas  47 , Philippe Poirier  48 , Marie-Noelle Peraldi  49 , Benjamin Poussot  50 , Stéphane Ranque  51 , Jean-Philippe Rerolle  52 , Boualem Sendid  38   39 , Renaud Snanoudj  53 , Jérôme Tourret  54 , Marc Vasse  55 , Cécile Vigneau  56 , Odile Villard  57 , Laurent Mesnard  1 , Fanny Lanternier  4   5 , Cédric Rafat  1
Affiliations

Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France

Laurène Tardieu et al. Pathogens. .

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.

Keywords: cryptococcal meningitis; cryptococcosis; graft outcome; opportunistic infection; renal transplantation; transplant associated diseases.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Density plot of distribution of the time between the first symptoms and the diagnosis.
Figure 2
Figure 2
Patient survival probability (a) and graft survival probability (b) after diagnosis of cryptococcosis depending on whether patients presented with CM or not.
Figure 3
Figure 3
Venn diagram representation summarizing brain injury patterns as displayed in imaging of patients with CM (n = 59/61).
Figure 4
Figure 4
Patient survival probability after diagnosis of CM with or without parenchyma lesion.
Figure 5
Figure 5
Patient survival probability after diagnosis of CM with or without vascular injury.
See this image and copyright information in PMC

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