Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factors
Background: Liver cirrhosis compromises immunity against cryptococcosis, and liver transplant recipients tend to develop the disease earlier after transplantation, possibly due to unrecognized pretransplant infection. We assessed the prevalence and characteristics of cryptococcosis among liver trans...
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Elsevier
2025-02-01
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| Series: | Journal of Microbiology, Immunology and Infection |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1684118224001452 |
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| author | Wan-Ting Tsai Aristine Cheng Yu-Chung Chuang Cheng-Maw Ho Yao-Ming Wu Ming-Chih Ho Hsin-Yun Sun Ray-Hung Hu Yee-Chun Chen |
| author_facet | Wan-Ting Tsai Aristine Cheng Yu-Chung Chuang Cheng-Maw Ho Yao-Ming Wu Ming-Chih Ho Hsin-Yun Sun Ray-Hung Hu Yee-Chun Chen |
| author_sort | Wan-Ting Tsai |
| collection | DOAJ |
| description | Background: Liver cirrhosis compromises immunity against cryptococcosis, and liver transplant recipients tend to develop the disease earlier after transplantation, possibly due to unrecognized pretransplant infection. We assessed the prevalence and characteristics of cryptococcosis among liver transplant candidates and whether pre-transplant cryptococcal antigen (CrAg) can detect the disease before transplantation. Methods: We retrospectively included liver transplant candidates in a tertiary hospital during 2017–2022. Serum CrAg and pulmonary computed tomography were incorporated in routine transplant evaluation. Other investigations were done if indicated. Cryptococcosis was diagnosed by positive culture or CrAg. Risk factors for cryptococcosis were also assessed. Results: Of the 377 candidates with a median MELD-Na score of 18, 84.4% had hepatitis B virus (HBV) infection. Cryptococcosis was diagnosed in 10 (2.6%) candidates, by CrAg in 6, culture in 2, or both in 2. Only 3 had fever, and 3 were asymptomatic; 7 had pulmonary cryptococcosis. Of the 10 candidates with cryptococcosis, one underwent transplantation after 143-day antifungals. Of the 87 candidates undergoing liver transplantation, one (1.2%) recipient developed cryptococcosis 14 days post-transplant with negative CrAg three weeks before transplantation. HBsAg-positive chronic HBV infection with HBV DNA loads <2000 IU/mL was significantly associated with cryptococcosis (odds ratio 4.4, 95% confidence interval 1.2–16.5, p = 0.03) after the adjustment of MELD-Na score. Conclusions: The prevalence of cryptococcosis was 2.6% among our liver transplant candidates and CrAg detected 80% of the cases. Disease presentation was mild and pulmonary disease predominated. HBsAg-positive chronic HBV infection with HBV DNA loads <2000 IU/mL was significantly associated with cryptococcosis. |
| format | Article |
| id | doaj-art-f00cba2578314440ac55ab81d84d890f |
| institution | Kabale University |
| issn | 1684-1182 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Microbiology, Immunology and Infection |
| spelling | doaj-art-f00cba2578314440ac55ab81d84d890f2025-02-06T05:11:18ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822025-02-01581103111Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factorsWan-Ting Tsai0Aristine Cheng1Yu-Chung Chuang2Cheng-Maw Ho3Yao-Ming Wu4Ming-Chih Ho5Hsin-Yun Sun6Ray-Hung Hu7Yee-Chun Chen8Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100225, Taiwan; Department of Internal Medicine, Taipei City Hospital, Zhongxiao Branch, Taipei, 103212, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100225, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100225, TaiwanDepartment of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100225, TaiwanDepartment of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100225, TaiwanDepartment of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100225, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100225, Taiwan; Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, 100225, Taiwan.Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100225, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100225, TaiwanBackground: Liver cirrhosis compromises immunity against cryptococcosis, and liver transplant recipients tend to develop the disease earlier after transplantation, possibly due to unrecognized pretransplant infection. We assessed the prevalence and characteristics of cryptococcosis among liver transplant candidates and whether pre-transplant cryptococcal antigen (CrAg) can detect the disease before transplantation. Methods: We retrospectively included liver transplant candidates in a tertiary hospital during 2017–2022. Serum CrAg and pulmonary computed tomography were incorporated in routine transplant evaluation. Other investigations were done if indicated. Cryptococcosis was diagnosed by positive culture or CrAg. Risk factors for cryptococcosis were also assessed. Results: Of the 377 candidates with a median MELD-Na score of 18, 84.4% had hepatitis B virus (HBV) infection. Cryptococcosis was diagnosed in 10 (2.6%) candidates, by CrAg in 6, culture in 2, or both in 2. Only 3 had fever, and 3 were asymptomatic; 7 had pulmonary cryptococcosis. Of the 10 candidates with cryptococcosis, one underwent transplantation after 143-day antifungals. Of the 87 candidates undergoing liver transplantation, one (1.2%) recipient developed cryptococcosis 14 days post-transplant with negative CrAg three weeks before transplantation. HBsAg-positive chronic HBV infection with HBV DNA loads <2000 IU/mL was significantly associated with cryptococcosis (odds ratio 4.4, 95% confidence interval 1.2–16.5, p = 0.03) after the adjustment of MELD-Na score. Conclusions: The prevalence of cryptococcosis was 2.6% among our liver transplant candidates and CrAg detected 80% of the cases. Disease presentation was mild and pulmonary disease predominated. HBsAg-positive chronic HBV infection with HBV DNA loads <2000 IU/mL was significantly associated with cryptococcosis.http://www.sciencedirect.com/science/article/pii/S1684118224001452Liver transplant candidatesCryptococcusCryptococcal antigen |
| spellingShingle | Wan-Ting Tsai Aristine Cheng Yu-Chung Chuang Cheng-Maw Ho Yao-Ming Wu Ming-Chih Ho Hsin-Yun Sun Ray-Hung Hu Yee-Chun Chen Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factors Journal of Microbiology, Immunology and Infection Liver transplant candidates Cryptococcus Cryptococcal antigen |
| title | Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factors |
| title_full | Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factors |
| title_fullStr | Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factors |
| title_full_unstemmed | Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factors |
| title_short | Cryptococcosis in wait-listed liver transplant candidates: Prevalence, manifestations, and risk factors |
| title_sort | cryptococcosis in wait listed liver transplant candidates prevalence manifestations and risk factors |
| topic | Liver transplant candidates Cryptococcus Cryptococcal antigen |
| url | http://www.sciencedirect.com/science/article/pii/S1684118224001452 |
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