Cryptococcus neoformans in organ transplant recipients:: Impact of calcineurin-inhibitor agents on mortality

Variables influencing the risk of dissemination and outcome of Cryptococcus neoformans infection were assessed in 111 organ transplant recipients with cryptococcosis in a prospective, multicenter, international study. Sixty-one percent ( 68/111) of the patients had disseminated infection. The risk of disseminated cryptococcosis was significantly higher for liver transplant recipients ( adjusted hazard ratio [ HR], P = 6.65;). The overall mortality rate at 90 days was 14% ( 16/111). The mortality rate was higher in patients with abnormal mental status (P = .023), renal failure at baseline (P = .028), fungemia (P = .006), and disseminated infection (P = 0.35) and was lower in those receiving a calcineurin-inhibitor agent (P = .003). In a multivariable analysis, the receipt of a calcineurin-inhibitor agent was independently associated with a lower mortality ( adjusted HR, 0.21; P = .008), and renal failure at baseline with a higher mortality rate ( adjusted HR, 3.14; P = 0.37). Thus, outcome in transplant recipients with cryptococcosis appears to be influenced by the type of immunosuppressive agent employed. Additionally, discerning the basis for transplant type-specific differences in disease severity has implications relevant for yielding further insights into the pathogenesis of C. neoformans infection in transplant recipients.