Title

Cryptococcosis in Patients With Cirrhosis of the Liver and Posttransplant Outcomes.

Document Type

Article

Publication Date

10-1-2015

Publication Title

Transplantation

Abstract

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

PubMed ID

25806406

Volume

99

Issue

10

First Page

2132

Last Page

2141

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