Epidemiology Of Cryptococcosis And Cryptococcal Meningitis In A Large Retrospective Cohort Of Patients Following Solid Organ Transplantation

Abstract

Abstract Background: Cryptococcosis is the third most common invasive fungal infection in solid organ transplant (SOT) recipients. There are no nationally representative data describing the incidence, risk factors and outcomes of cryptococcosis after SOT. Methods: We assembled a large cohort of adult SOT recipients using ICD-9 CM billing data from HCUP State Inpatient Databases of Florida (2006-2012), New York (2006-2011) and California (2004-2010). Demographics, comorbidities, death, and cryptococcal infections coded during hospitalization were identified. Results: 42,634 adults with SOT were identified during the study period. Cryptococcal disease was identified in 0.37 % (n=158), of which 44% had meningitis (n=69). Median time to diagnosis of cryptococcosis was 464 days (range 4 – 2,393). The median time to onset of cryptococcosis was earlier for lung (191 days; range 7.5 – 1,816), heart (195 days; range 4 – 1,061) and liver (200 days; range 4 – 1,581) compared to kidney transplant recipients (616 days; range 12 – 2,393); P < 0.001 log rank test. Very early–onset disease (< 30 days after transplantation) more frequently occurred in liver and lung transplant recipients. Lung transplant recipients had the highest risk of cryptococcosis (HR 2.10; CI 1.21 – 3.60). Cryptococcosis was associated with death (HR 2.29; CI 1.68 – 3.11), after adjusting for age, type of SOT, prior transplant failure/rejection, diabetes, and other comorbidities. Conclusion: Cryptococcosis is rare after SOT but associated with significantly increased risk of death. Lung transplant recipients are at highest risk for cryptococcosis among SOT’s. Non-kidney transplants have earlier onset of cryptococcosis and higher risk of death compared to kidney transplant recipients.