Cryptococcosis in liver and kidney transplant recipients receiving anti-thymocyte globulin or alemtuzumab.
Transpl Infect Dis
; 9(1): 22-7, 2007 Mar.
Article
em En
| MEDLINE
| ID: mdl-17313467
ABSTRACT
Rabbit anti-thymocyte globulin (ATG) and alemtuzumab have been used for induction or preconditioning and for the treatment of acute rejection in organ transplant recipients in many centers. Such regimens may lead to a substantial decline in the CD4 lymphocyte count to levels seen in other population groups at high risk of cryptococcosis. In view of this, we examined the impact of such therapy on the cumulative incidence of cryptococcosis among liver and kidney recipients. A total of 834 liver and 727 kidney transplants were performed during the study period. Seven hundred and eighty-one patients did not receive ATG or alemtuzumab; 646 received 1 dose of either drug, and 134 patients received 2 doses of either drug. The cumulative incidence of cryptococcosis was 0.26% (2/781) among those who did not receive ATG or alemtuzumab; 0.3% (2/646) among those who received only 1 dose, and 2.24% (3/134) among those who received 2 doses (P=0.03). There were 5 cases of cryptococcosis in liver recipients and 2 in kidney recipients. There were 3 cases of cryptococcal meningitis, 3 of pneumonia, and 1 of disseminated disease. The 2 kidney recipients had meningitis. Diagnosis occurred at a median of 255 days (range 7-517) after transplantation. The mortality rate was 14.2%. We conclude that the use of 1 dose of ATG or alemtuzumab is not associated with an increased cumulative incidence of cryptococcosis, but that those patients receiving 2 doses are at increased risk.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
/
Imunoglobulinas
/
Transplante de Rim
/
Transplante de Fígado
/
Criptococose
/
Rejeição de Enxerto
/
Anticorpos Monoclonais
/
Anticorpos Antineoplásicos
/
Antineoplásicos
Tipo de estudo:
Incidence_studies
/
Prognostic_studies
Limite:
Aged
/
Animals
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Transpl Infect Dis
Assunto da revista:
TRANSPLANTE
Ano de publicação:
2007
Tipo de documento:
Article
País de afiliação:
Estados Unidos