Ponzio Vinicius, Camargo Luis Fernando, Medina-Pestana José, Perfect John Robert, Colombo Arnaldo Lopes
Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Discipline of Nephrology, Hospital do Rim Oswaldo Ramos Foundation, Universidade Federal de São Paulo, São Paulo, Brazil.
Transpl Infect Dis. 2018 Aug;20(4):e12910. doi: 10.1111/tid.12910. Epub 2018 May 30.
Cryptococcosis is the second most common cause of invasive fungal infections in renal transplant recipients in many countries, and data on graft outcome after treatment for this infection is lacking in less-resourced health care settings.
Data from 47 renal transplant recipients were retrospectively collected at a single institution during a period of 13 years. Graft dysfunction, graft loss, and mortality rates were evaluated. Predictors of mortality and graft loss were estimated.
A total of 38 (97.4%) patients treated with amphotericin B deoxycholate (AMBd) showed graft dysfunction after antifungal initiation and 8 (18.2%) had kidney graft loss. Graft loss within 30 days after cryptococcosis onset was significantly associated with disseminated infection, greater baseline creatinine levels, and graft dysfunction concomitant to AMBd therapy and an additional nephrotoxic condition. The 30-day mortality rate was 19.2% and it was significantly associated with disseminated and pulmonary infections, somnolence at admission, high CSF opening pressure, positive CSF India ink, creatinine levels greater than 2.0 mg/dL at admission, graft dysfunction in patients treated with AMBd and an additional nephrotoxic condition and graft loss within 30 days.
Graft dysfunction was common in renal transplant recipients with cryptococcosis treated with AMBd. The rate of graft loss rate was high, most frequently in patients with concomitant nephrotoxic conditions. Therefore, the clinical focus should be on the use of less nephrotoxic lipid formulations of amphotericin B in this specific population requiring a polyene induction regimen for treatment of severe cryptococcosis in all health care systems caring for transplantation recipients.
在许多国家，隐球菌病是肾移植受者侵袭性真菌感染的第二大常见病因，在资源匮乏的医疗环境中，缺乏关于这种感染治疗后移植物结局的数据。
在13年期间，在一家单一机构回顾性收集了47例肾移植受者的数据。评估了移植物功能障碍、移植物丢失和死亡率。估计了死亡率和移植物丢失的预测因素。
共有38例（97.4%）接受去氧胆酸盐两性霉素B（AMBd）治疗的患者在开始抗真菌治疗后出现移植物功能障碍，8例（18.2%）出现肾移植物丢失。隐球菌病发病后30天内的移植物丢失与播散性感染、更高的基线肌酐水平、AMBd治疗伴随的移植物功能障碍以及另一种肾毒性情况显著相关。30天死亡率为19.2%，它与播散性和肺部感染、入院时嗜睡、脑脊液开放压高、脑脊液墨汁染色阳性、入院时肌酐水平大于2.0mg/dL、接受AMBd治疗的患者的移植物功能障碍以及另一种肾毒性情况和30天内的移植物丢失显著相关。
在接受AMBd治疗的肾移植受者隐球菌病患者中，移植物功能障碍很常见。移植物丢失率很高，最常见于伴有肾毒性情况的患者。因此，在所有为移植受者提供护理的医疗系统中，对于这个需要多烯诱导方案治疗严重隐球菌病的特定人群，临床重点应是使用肾毒性较小的两性霉素B脂质制剂。
