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Characteristics and Outcomes Following Pulmonary Cryptococcosis in Solid Organ Transplantation: Comparison With Nonsolid Organ Transplant Patients FREE TO VIEW

Angel Brown, MD; Keith Wille, MD; John Baddley, MD; Peter Pappas, MD
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University of Alabama - Birmingham, Birmingham, AL

Chest. 2013;144(4_MeetingAbstracts):1020A. doi:10.1378/chest.1703329
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SESSION TITLE: Post-Transplant Complications

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM

PURPOSE: Cryptococcosis is a common invasive fungal infection in solid organ transplant (SOT) patients. However, the relationship between immune status and outcomes in pulmonary cryptococcosis has not been examined in the SOT population. Goals of this investigation were to assess clinical characteristics, treatment, and outcomes in SOT patients with pulmonary cryptococcosis, as compared to non-transplant (NSOT).

METHODS: We conducted a retrospective review of cases of pulmonary cryptococcosis diagnosed at UAB from 1996-2011. HIV patients were excluded. Data collected included baseline characteristics, transplant status, disease site, treatment, and outcomes. Comparisons between SOT and NSOT (non-solid organ transplant, non-HIV, and non-bone marrow transplant) patients were made using t-test or Wilcoxon rank sum and χ2 as indicated. Survival was compared using Kaplan-Meier methods.

RESULTS: Of 77 patients with pulmonary cryptococcosis, 32 were SOT recipients and 45 were NSOT patients. Baseline demographics (age, gender, and race) and frequency of disseminated disease were similar in the two groups. SOT patients were more likely to have prolonged duration of therapy with a median length of 366±346 vs. 247±355 days, respectively (p=0.009). The proportion of SOT and NSOT patients achieving full recovery (symptom and radiologic improvement) was comparable at 6 months, 58.6% vs. 51.9%, respectively (p=0.35). The survival rates for the two groups were 97%(SOT) vs. 84%(NSOT), (p=0.13) at 3 months and 88%(SOT) vs. 76 %(NSOT), (p=0.25) at 12 months following treatment initiation.

CONCLUSIONS: There were few differences between the groups overall. SOT patients received a longer duration of antifungal therapy and there was a trend toward better survival in the SOT patients. SOT patients appear to respond favorably to cryptococcal therapy with good clinical outcomes. Future studies exploring the rationale for prolonged duration of therapy in post-transplant patients are needed.

CLINICAL IMPLICATIONS: The future implications of this research include a shorter duration of antifungal therapy for SOT patients with pulmonary cryptococcosis, an investigation of what role clinician preference has on the duration of therapy, as well as a possible revision of current treatment guidelines.

DISCLOSURE: The following authors have nothing to disclose: Angel Brown, Keith Wille, John Baddley, Peter Pappas

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