Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients

Hsin Yun Sun, Barbara D. Alexander, Olivier Lortholary, Francoise Dromer, Graeme N. Forrest, G. Marshall Lyon, Jyoti Somani, Krishan L. Gupta, Ramon Del Busto, Timothy L. Pruett, Costi D. Sifri, Ajit P. Limaye, George T. John, Goran B. Klintmalm, Kenneth Pursell, Valentina Stosor, Michele I. Morris, Lorraine A. Dowdy, Patricia Munoz, Andre C KalilJulia Garcia-Diaz, Susan L. Orloff, Andrew A. House, Sally H. Houston, Dannah Wray, Shirish Huprikar, Leonard B. Johnson, Atul Humar, Raymund R. Razonable, Robert A. Fisher, Shahid Husain, Marilyn M. Wagener, Nina Singh

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background. Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known. Methods. Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days after transplantation, respectively. Results. Very early-onset disease developed in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6% (5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcus isolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor-acquired infection. Conclusions. A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.

Original languageEnglish (US)
Pages (from-to)1062-1069
Number of pages8
JournalClinical Infectious Diseases
Volume51
Issue number9
DOIs
StatePublished - Nov 1 2010

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Cryptococcosis
Tissue Donors
Transplants
Transplantation
Allografts
Liver
Fungemia
Cryptococcus
Surgical Wound Infection
Transplant Recipients
Lung
Infection

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Sun, H. Y., Alexander, B. D., Lortholary, O., Dromer, F., Forrest, G. N., Lyon, G. M., ... Singh, N. (2010). Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients. Clinical Infectious Diseases, 51(9), 1062-1069. https://doi.org/10.1086/656584

Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients. / Sun, Hsin Yun; Alexander, Barbara D.; Lortholary, Olivier; Dromer, Francoise; Forrest, Graeme N.; Lyon, G. Marshall; Somani, Jyoti; Gupta, Krishan L.; Del Busto, Ramon; Pruett, Timothy L.; Sifri, Costi D.; Limaye, Ajit P.; John, George T.; Klintmalm, Goran B.; Pursell, Kenneth; Stosor, Valentina; Morris, Michele I.; Dowdy, Lorraine A.; Munoz, Patricia; Kalil, Andre C; Garcia-Diaz, Julia; Orloff, Susan L.; House, Andrew A.; Houston, Sally H.; Wray, Dannah; Huprikar, Shirish; Johnson, Leonard B.; Humar, Atul; Razonable, Raymund R.; Fisher, Robert A.; Husain, Shahid; Wagener, Marilyn M.; Singh, Nina.

In: Clinical Infectious Diseases, Vol. 51, No. 9, 01.11.2010, p. 1062-1069.

Research output: Contribution to journalArticle

Sun, HY, Alexander, BD, Lortholary, O, Dromer, F, Forrest, GN, Lyon, GM, Somani, J, Gupta, KL, Del Busto, R, Pruett, TL, Sifri, CD, Limaye, AP, John, GT, Klintmalm, GB, Pursell, K, Stosor, V, Morris, MI, Dowdy, LA, Munoz, P, Kalil, AC, Garcia-Diaz, J, Orloff, SL, House, AA, Houston, SH, Wray, D, Huprikar, S, Johnson, LB, Humar, A, Razonable, RR, Fisher, RA, Husain, S, Wagener, MM & Singh, N 2010, 'Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients', Clinical Infectious Diseases, vol. 51, no. 9, pp. 1062-1069. https://doi.org/10.1086/656584
Sun HY, Alexander BD, Lortholary O, Dromer F, Forrest GN, Lyon GM et al. Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients. Clinical Infectious Diseases. 2010 Nov 1;51(9):1062-1069. https://doi.org/10.1086/656584
Sun, Hsin Yun ; Alexander, Barbara D. ; Lortholary, Olivier ; Dromer, Francoise ; Forrest, Graeme N. ; Lyon, G. Marshall ; Somani, Jyoti ; Gupta, Krishan L. ; Del Busto, Ramon ; Pruett, Timothy L. ; Sifri, Costi D. ; Limaye, Ajit P. ; John, George T. ; Klintmalm, Goran B. ; Pursell, Kenneth ; Stosor, Valentina ; Morris, Michele I. ; Dowdy, Lorraine A. ; Munoz, Patricia ; Kalil, Andre C ; Garcia-Diaz, Julia ; Orloff, Susan L. ; House, Andrew A. ; Houston, Sally H. ; Wray, Dannah ; Huprikar, Shirish ; Johnson, Leonard B. ; Humar, Atul ; Razonable, Raymund R. ; Fisher, Robert A. ; Husain, Shahid ; Wagener, Marilyn M. ; Singh, Nina. / Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients. In: Clinical Infectious Diseases. 2010 ; Vol. 51, No. 9. pp. 1062-1069.
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title = "Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients",
abstract = "Background. Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known. Methods. Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days after transplantation, respectively. Results. Very early-onset disease developed in 9 (5{\%}) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6{\%} (5 of 9) of the patients with very early-onset disease versus 25.9{\%} (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6{\%} vs 7.2{\%}; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcus isolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor-acquired infection. Conclusions. A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.",
author = "Sun, {Hsin Yun} and Alexander, {Barbara D.} and Olivier Lortholary and Francoise Dromer and Forrest, {Graeme N.} and Lyon, {G. Marshall} and Jyoti Somani and Gupta, {Krishan L.} and {Del Busto}, Ramon and Pruett, {Timothy L.} and Sifri, {Costi D.} and Limaye, {Ajit P.} and John, {George T.} and Klintmalm, {Goran B.} and Kenneth Pursell and Valentina Stosor and Morris, {Michele I.} and Dowdy, {Lorraine A.} and Patricia Munoz and Kalil, {Andre C} and Julia Garcia-Diaz and Orloff, {Susan L.} and House, {Andrew A.} and Houston, {Sally H.} and Dannah Wray and Shirish Huprikar and Johnson, {Leonard B.} and Atul Humar and Razonable, {Raymund R.} and Fisher, {Robert A.} and Shahid Husain and Wagener, {Marilyn M.} and Nina Singh",
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T1 - Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients

AU - Sun, Hsin Yun

AU - Alexander, Barbara D.

AU - Lortholary, Olivier

AU - Dromer, Francoise

AU - Forrest, Graeme N.

AU - Lyon, G. Marshall

AU - Somani, Jyoti

AU - Gupta, Krishan L.

AU - Del Busto, Ramon

AU - Pruett, Timothy L.

AU - Sifri, Costi D.

AU - Limaye, Ajit P.

AU - John, George T.

AU - Klintmalm, Goran B.

AU - Pursell, Kenneth

AU - Stosor, Valentina

AU - Morris, Michele I.

AU - Dowdy, Lorraine A.

AU - Munoz, Patricia

AU - Kalil, Andre C

AU - Garcia-Diaz, Julia

AU - Orloff, Susan L.

AU - House, Andrew A.

AU - Houston, Sally H.

AU - Wray, Dannah

AU - Huprikar, Shirish

AU - Johnson, Leonard B.

AU - Humar, Atul

AU - Razonable, Raymund R.

AU - Fisher, Robert A.

AU - Husain, Shahid

AU - Wagener, Marilyn M.

AU - Singh, Nina

PY - 2010/11/1

Y1 - 2010/11/1

N2 - Background. Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known. Methods. Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days after transplantation, respectively. Results. Very early-onset disease developed in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6% (5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcus isolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor-acquired infection. Conclusions. A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.

AB - Background. Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known. Methods. Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days after transplantation, respectively. Results. Very early-onset disease developed in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6% (5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcus isolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor-acquired infection. Conclusions. A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.

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