Cryptococcosis in Patients With Cirrhosis of the Liver and Posttransplant Outcomes
Singh N, Sifri CD, Silveira FP, Miller R, Gregg KS, Huprikar S, Lease ED, Zimmer A, Dummer JS, Spak CW, Koval C, Banach DB, Shroff M, Le J, Ostrander D, Avery R, Eid A, Razonable RR, Montero J, Blumberg E, Alynbiawi A, Morris MI, Randall HB, Alangaden G, Tessier J, Wagener MM, and Sun HY. Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes Transplantation 2015; 99(10):2132-2141.
BACKGROUND: The outcomes and optimal management of cirrhotic patients who develop cryptococcosis before transplantation are not fully known.
METHODS: We conducted a multicenter study involving consecutive patients with cirrhosis and cryptococcosis between January 2000 and March 2014. Data collected were generated as standard of care.
RESULTS: In all, 112 patients were followed until death or up to 9 years. Disseminated disease and fungemia were present in 76.8% (86/112) and 90-day mortality was 57.1% (64/112). Of the 39 patients listed for transplant, 20.5% (8) underwent liver transplantation, including 2 with active but unrecognized disease before transplantation. Median duration of pretransplant antifungal therapy and posttransplant therapy was 43 days (interquartile range, 8-130 days) and 272 days (interquartile range, 180-630 days), respectively. Transplantation was associated with lower mortality (P = 0.002). None of the transplant recipients developed disease progression during the median follow-up of 3.5 years with a survival rate of 87.5%.
CONCLUSIONS: Cryptococcosis in patients with cirrhosis has grave prognosis. Our findings suggest that transplantation after recent cryptococcal disease may not be a categorical exclusion and may be cautiously undertaken in liver transplant candidates who are otherwise deemed clinically stable.
Medical Subject Headings
Antifungal Agents; Cryptococcosis; Disease Progression; Female; Fluconazole; Humans; Liver; Liver Cirrhosis; Liver Transplantation; Male; Middle Aged; Prognosis; Risk Factors; Transplant Recipients; Treatment Outcome