CRYPTOCOCCAL MENINGITIS AFTER LIVER-TRANSPLANTATION

We present our experience with 10 liver transplant recipients in whom cryptococcal meningitis developed after liver transplantation. Disease developed a median period of 3.5 months (range, 2-36 months) after tr ansplantation and patients were diagnosed a median period of 9 days (r ange, 2-90 days) after initial symptoms. Headache, fever, and mental s tatus changes were the most frequent clinical presentations, while men ingismus was found in only 30% of patients. Cerebrospinal fluid analys is was diagnostic in all cases. All patients were treated with amphote ricin B and flucytosine. Immunosuppression was either decreased or dis continued during therapy. Five patients died, four as a direct result of cryptococcal infection and one as a result of chronic rejection. Th ree patients had long-term survival without any sequelae. One long-ter m survivor suffered blindness consequent to the disease, We conclude t hat cryptococcal meningitis is a rare complication in liver transplant recipients (0.25%), and has a high mortality rate (50%), Early recogn ition, combination antifungal therapy, and decrease or discontinuation of immunosuppression are important for cure. No relapse has been seen in surviving patients.