Abstract: SA-PO1085
Cryptococcosis in Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Tardieu, Laurène, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
- Divard, Gillian, Hopital Universitaire Necker-Enfants Malades, Paris, France
- Mesnard, Laurent, Hopital Tenon, Paris, Île-de-France, France
- Rerolle, Jean-philippe, CHU Dupuytren 2, Limoges, France
- Frimat, Marie, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France
- Vigneau, Cecile M., Hopital Pontchaillou, Rennes, France
- Choukroun, Gabriel, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, Hauts-de-France, France
- Buchler, Matthias, Hopital Bretonneau, Tours, Centre, France
- Snanoudj, Renaud, Hopital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
- Moal, Valerie, Assistance Publique Hopitaux de Marseille, Marseille, Provence-Alpes-Côte d'Azu, France
- Lequintrec-Donnette, Moglie, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
- Kaminski, Hannah, Universite de Bordeaux, Talence, Aquitaine, France
- Rafat, Cedric, Hopital Tenon, Paris, Île-de-France, France
Background
Cryptococcosis is the third most common invasive fungal infection in solid organ transplant recipients. Clinical management and disease prognosis have already been previously scrutinized in this setting but had yet to be investigated specifically in kidney transplant recipients(KTr).
Methods
We carried out a cohort study of patients diagnosed with cryptococcosis after KT in France. Cases were matched with controls derived from a multicenter KT database. Our main objective was to describe course of graft function and patient survival. Secondary endpoints consisted in investigating practices pertaining to immunosuppressive treatment adjustments, identifying risk factors. Multivariable analysis was performed using conditional logistic regression to identify risk factors for cryptococcosis.
Results
Eighty-eight patients were included, matched with 79 controls. During induction treatment of cryptococcosis, 37.5% of patients presented with acute kidney injury (AKI) with 13.3% warranting renal replacement therapy. 35.5% of AKI were caused by drug toxicity. 34% of the patients experienced 1 side effect :amphotericin B-related nephrotoxicity predominated (39%) and was characterized by AKI in every case. All surviving patients were exposed to azole treatment. Of these, 41.8% experienced an overdose of tacrolimus, half of which were complicated by AKI.
Twelve months after diagnosis of cryptococcosis or equivalent period for controls, 22.4% of KTr experienced loss of graft function compared with 1.4% for control KTr (p<0.001). In 61.4% of patients on mycofenolate mofetil, drug was stopped whereas it was continued at unchanged doses in 12.3%.Dose of calcineurin inhibitors was not modified in 42.4% and reduced in 37.9%.
Upon multivariable analysis, patient's age (OR 1.04 p=0.004) and history of rejection (OR 2.32 p=0.04) were significantly associated with the development of cryptococcosis.
Conclusion
Cryptococcosis is associated with a highly impact on overall and kidney graft survival in KTr. Risk of acute graft dysfunction followed a threefold temporal sequence characterized by amphotericin-related tubular injury, tacrolimus overdose due to fluconazole/tacrolimus interaction through CYP competition and acute graft rejection in the setting of immunosuppression tapering.
Funding
- Clinical Revenue Support