Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes

Nina Singh, Costi D. Sifri, Fernanda P. Silveira, Rachel Miller, Kevin S. Gregg, Shirish Huprikar, Erika D. Lease, Andrea Zimmer, J. Stephen Dummer, Cedric W. Spak, Christine Koval, David B. Banach, Miloni Shroff, Jade Le, Darin Ostrander, Robin Avery, Albert Eid, Raymund R. Razonable, Jose Montero, Emily BlumbergAhlaam Alynbiawi, Michele I Morris, Henry B. Randall, George Alangaden, Jeffrey Tessier, Marilyn M. Wagener, Hsin Yun Sun

Research output: Contribution to journalArticle

11 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2132-2141
Number of pages10
JournalTransplantation
Volume99
Issue number10
DOIs
StatePublished - 2015

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Cryptococcosis
Liver Cirrhosis
Transplantation
Fibrosis
Fungemia
Transplants
Mortality
Standard of Care
Liver Transplantation
Multicenter Studies
Disease Progression
Survival Rate
Liver
Therapeutics

ASJC Scopus subject areas

  • Transplantation

Cite this

Singh, N., Sifri, C. D., Silveira, F. P., Miller, R., Gregg, K. S., Huprikar, S., ... Sun, H. Y. (2015). Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes. Transplantation, 99(10), 2132-2141. https://doi.org/10.1097/TP.0000000000000690

Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes. / Singh, Nina; Sifri, Costi D.; Silveira, Fernanda P.; Miller, Rachel; Gregg, Kevin S.; Huprikar, Shirish; Lease, Erika D.; Zimmer, Andrea; Stephen Dummer, J.; Spak, Cedric W.; Koval, Christine; Banach, David B.; Shroff, Miloni; Le, Jade; Ostrander, Darin; Avery, Robin; Eid, Albert; Razonable, Raymund R.; Montero, Jose; Blumberg, Emily; Alynbiawi, Ahlaam; Morris, Michele I; Randall, Henry B.; Alangaden, George; Tessier, Jeffrey; Wagener, Marilyn M.; Sun, Hsin Yun.

In: Transplantation, Vol. 99, No. 10, 2015, p. 2132-2141.

Research output: Contribution to journalArticle

Singh, N, Sifri, CD, Silveira, FP, Miller, R, Gregg, KS, Huprikar, S, Lease, ED, Zimmer, A, Stephen Dummer, J, 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 & Sun, HY 2015, 'Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes', Transplantation, vol. 99, no. 10, pp. 2132-2141. https://doi.org/10.1097/TP.0000000000000690
Singh N, Sifri CD, Silveira FP, Miller R, Gregg KS, Huprikar S et al. Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes. Transplantation. 2015;99(10):2132-2141. https://doi.org/10.1097/TP.0000000000000690
Singh, Nina ; Sifri, Costi D. ; Silveira, Fernanda P. ; Miller, Rachel ; Gregg, Kevin S. ; Huprikar, Shirish ; Lease, Erika D. ; Zimmer, Andrea ; Stephen Dummer, J. ; Spak, Cedric W. ; Koval, Christine ; Banach, David B. ; Shroff, Miloni ; Le, Jade ; Ostrander, Darin ; Avery, Robin ; Eid, Albert ; Razonable, Raymund R. ; Montero, Jose ; Blumberg, Emily ; Alynbiawi, Ahlaam ; Morris, Michele I ; Randall, Henry B. ; Alangaden, George ; Tessier, Jeffrey ; Wagener, Marilyn M. ; Sun, Hsin Yun. / Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes. In: Transplantation. 2015 ; Vol. 99, No. 10. pp. 2132-2141.
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T1 - Cryptococcosis in patients with cirrhosis of the liver and posttransplant outcomes

AU - Singh, Nina

AU - Sifri, Costi D.

AU - Silveira, Fernanda P.

AU - Miller, Rachel

AU - Gregg, Kevin S.

AU - Huprikar, Shirish

AU - Lease, Erika D.

AU - Zimmer, Andrea

AU - Stephen Dummer, J.

AU - Spak, Cedric W.

AU - Koval, Christine

AU - Banach, David B.

AU - Shroff, Miloni

AU - Le, Jade

AU - Ostrander, Darin

AU - Avery, Robin

AU - Eid, Albert

AU - Razonable, Raymund R.

AU - Montero, Jose

AU - Blumberg, Emily

AU - Alynbiawi, Ahlaam

AU - Morris, Michele I

AU - Randall, Henry B.

AU - Alangaden, George

AU - Tessier, Jeffrey

AU - Wagener, Marilyn M.

AU - Sun, Hsin Yun

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

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