Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France

• Published in: Pathogens (Basel) Vol. 11; no. 6; p. 699
• Main Authors: Tardieu, Laurène, Divard, Gillian, Lortholary, Olivier, Scemla, Anne, Rondeau, Éric, Accoceberry, Isabelle, Agbonon, Rémi, Alanio, Alexandre, Angoulvant, Adela, Albano, Laetitia, Attias, Philippe, Bellanger, Anne Pauline, Bertrand, Dominique, Bonhomme, Julie, Botterel, Françoise, Bouvier, Nicolas, Buchler, Matthias, Chouaki, Taieb, Crépin, Thomas, Durieux, Marie-Fleur, Desoubeaux, Guillaume, Doppelt, Gary, Favennec, Loïc, Fekkar, Arnaud, Fourdinier, Ophélie, Frimat, Marie, Gangneux, Jean-Pierre, Garandeau, Claire, Hasseine, Lilia, Hennequin, Christophe, Iriart, Xavier, Kamar, Nassim, Kaminski, Hannah, Kormann, Raphael, Lachaud, Laurence, Legendre, Christophe, Le Quintrec Donnette, Moglie, Leroy, Jordan, Levi, Charlène, Machouart, Marie, Marx, David, Menotti, Jean, Moal, Valérie, Morio, Florent, Mrozek, Natacha, Nicolas, Muriel, Poirier, Philippe, Peraldi, Marie-Noelle, Poussot, Benjamin, Ranque, Stéphane, Rerolle, Jean-Philippe, Sendid, Boualem, Snanoudj, Renaud, Tourret, Jérôme, Vasse, Marc, Vigneau, Cécile, Villard, Odile, Mesnard, Laurent, Lanternier, Fanny, Rafat, Cédric
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 17-06-2022; MDPI
• Subjects: Antigens; Brain; Brain injury; Cohort analysis; cryptococcal meningitis; Cryptococcosis; Diabetes; Fungal infections; graft outcome; Head injuries; HIV; Human immunodeficiency virus; Hyponatremia; Kidney transplantation; Laboratories; Life Sciences; Magnetic resonance imaging; Medical prognosis; Meningitis; Microbiology and Parasitology; Mortality; Neuroimaging; opportunistic infection; Patients; renal transplantation; transplant associated diseases; Transplants & implants; France; cryptococcal meningitis; opportunistic infection; renal transplantation; transplant associated diseases; cryptococcosis; graft outcome; Renal transplantation; Opportunistic infection; Transplant associated diseases; Cryptococcal meningitis; Graft outcome; Cryptococcosis
• ISSN: 2076-0817; 2076-0817
• DOI: 10.3390/pathogens11060699

Cryptococcosis is the third most common cause of invasive fungal infection in solid organ transplant recipients and cryptococcal meningitis (CM) its main clinical presentation. CM outcomes, as well as its clinical features and radiological characteristics, have not yet been considered on a large scale in the context of kidney transplantation (KT). We performed a nationwide retrospective study of adult patients diagnosed with cryptococcosis after KT between 2002 and 2020 across 30 clinical centers in France. We sought to describe overall and graft survival based on whether KT patients with cryptococcosis developed CM or not. Clinical indicators of CNS involvement and brain radiological characteristics were assessed. Eighty-eight cases of cryptococcosis were diagnosed during the study period, with 61 (69.3%) cases of CM. Mortality was high (32.8%) at 12 months (M12) but not significantly different whether or not patients presented with CM. Baseline hyponatremia and at least one neurological symptom were independently associated with CM (p < 0.001). Positive serum cryptococcal antigen at diagnosis was also significantly associated with CM (p < 0.001). On magnetic resonance imaging (MRI), three patterns of brain injury were identified: parenchymal, meningeal, and vascular lesions. Although CM does not affect graft function directly, it entails a grim prognosis.