Cryptococcus neoformans infection in organ transplant recipients: Variables influencing clinical characteristics and outcome

Unique clinical characteristics and other variables influencing the outcome of Cryptococcus neoformans infection in organ transplant recipients have n ot been well defined. From a review of published reports, we found that C. neoformans infection was documented in 2.8% of organ transplant recipients (overall death rate 42%). The type of primary immunosuppressive agent used in transplantation influenced the predominant clinical manifestation of cry ptococcosis. Patients receiving tacrolimus were significantly less likely t o have central nervous system involvement (78% versus 11%, p=0.001) and mor e likely to have skin, soft-tissue, and osteoarticular involvement (66% ver sus 21%, p = 0.006) than patients receiving nontacrolimus-based immunosuppr ession. Renal failure at admission was the only independently significant p redictor of death in these patients (odds ratio 16.4, 95% Cl 1.9-143, p = 0 .004). Hypotheses based on these data may elucidate the pathogenesis and ma y ultimately guide the management of C. neoformans infection in organ trans plant recipients.