Miwa Toshiki, Okamoto Koh, Ikeuchi Kazuhiko, Yamamoto Shinya, Okugawa Shu, Ichida Akihiko, Akamatsu Nobuhisa, Hasegawa Kiyoshi, Tsutsumi Takeya
Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan.
Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Open Forum Infect Dis. 2024 May 17;11(5):ofae255. doi: 10.1093/ofid/ofae255. eCollection 2024 May.
Cryptococcosis is a notable infectious complication of liver transplantation. Currently, there is no recommendation for screening serum cryptococcal antigen (CrAg) levels in solid organ transplant recipients. We aimed to explore the role of serum CrAg in liver transplant recipients at an institution where posttransplant serum CrAg has been widely tested.
This retrospective study was conducted at a tertiary care center in Japan. All liver transplant recipients with serum CrAg measured either for screening or for diagnostic testing at least once after transplantation between April 2005 and March 2022 were included. For participants with either a positive CrAg test result or positive culture for , we manually reviewed clinical manifestations, management, and prognosis from the medical records.
During the study period, 12 885 serum CrAg tests (median, 16 tests per patient) were performed in 468 liver transplant recipients. The 1-year posttransplant incidence of positive serum CrAg test results and culture-proven cryptococcosis was 1.9% (9/468) and 0.6% (3/468), respectively. No patient with persistently negative serum CrAg test results showed growth of in culture. Four patients had clinical manifestations consistent with cryptococcosis, of whom 2 (50.0%) started antifungal therapy promptly based on a positive serum CrAg test result. In contrast, 5 patients had no clinical manifestations. Three of the 5 (60.0%) patients did not receive antifungal therapy and remained free of clinical manifestations.
Serum CrAg test was more sensitive than culture among liver transplant recipients and prompted early diagnosis and antifungal therapy in symptomatic patients. However, serial screening of serum CrAg in asymptomatic patients may be of little value, with the potential for false-positive results.
隐球菌病是肝移植中一种显著的感染性并发症。目前，对于实体器官移植受者，尚无筛查血清隐球菌抗原（CrAg）水平的建议。我们旨在探讨血清CrAg在一家已广泛检测移植后血清CrAg的机构中肝移植受者中的作用。
这项回顾性研究在日本的一家三级医疗中心进行。纳入2005年4月至2022年3月期间所有在移植后至少进行过一次血清CrAg检测以进行筛查或诊断的肝移植受者。对于CrAg检测结果为阳性或培养结果为阳性的参与者，我们人工查阅病历中的临床表现、治疗及预后情况。
在研究期间，对468例肝移植受者进行了12885次血清CrAg检测（中位数为每位患者16次检测）。移植后1年血清CrAg检测结果阳性及培养证实的隐球菌病发病率分别为1.9%（9/468）和0.6%（3/468）。血清CrAg检测结果持续为阴性的患者在培养中均未出现隐球菌生长。4例患者有符合隐球菌病的临床表现，其中2例（50.0%）基于血清CrAg检测结果阳性迅速开始抗真菌治疗。相比之下，5例患者无临床表现。这5例患者中有3例（60.0%）未接受抗真菌治疗且仍无临床表现。
在肝移植受者中，血清CrAg检测比培养更敏感，能促使对有症状患者进行早期诊断和抗真菌治疗。然而，对无症状患者进行血清CrAg的系列筛查可能价值不大，且有出现假阳性结果的可能。
