Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France.
Laurène TardieuGillian DivardOlivier LortholaryAnne ScemlaÉric RondeauIsabelle AccoceberryRémi AgbononAlexandre AlanioAdela AngoulvantLaetitia AlbanoPhilippe AttiasAnne Pauline BellangerDominique BertrandJulie BonhommeFrançoise BotterelNicolas BouvierMatthias BuchlerTaieb ChouakiThomas CrépinMarie-Fleur DurieuxGuillaume DesoubeauxGary DoppeltLoïc FavennecArnaud FekkarOphélie FourdinierMarie FrimatJean-Pierre GangneuxClaire GarandeauLilia HasseineChristophe HennequinXavier IriartNassim KamarHannah KaminskiRaphael KormannLaurence LachaudChristophe LegendreMoglie Le Quintrec DonnetteJordan LeroyCharlène LeviMarie MachouartDavid MarxJean MenottiValérie MoalFlorent MorioNatacha MrozekMuriel NicolasPhilippe PoirierMarie-Noelle PeraldiBenjamin PoussotStéphane RanqueJean-Philippe RerolleBoualem SendidRenaud SnanoudjJérôme TourretMarc VasseCécile VigneauOdile VillardLaurent MesnardFanny LanternierCédric RafatPublished in: Pathogens (Basel, Switzerland) (2022)
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.