Cryptococcus neoformans in organ transplant recipients:: Impact of calcineurin-inhibitor agents on mortality
Cryptococcus neoformans in organ transplant recipients:: Impact of calcineurin-inhibitor agents on mortality
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DOI：
10.1086/511438
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发表时间：
2007-03-01
影响因子：
6.4
通讯作者：
Husain, Shahid
中科院分区：
文献类型：
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作者：
Singh, Nina;Alexander, Barbara D.;Husain, Shahid
在一项前瞻性、多中心、国际研究中，对111例器官移植受者隐球菌感染传播风险和结果的影响变量进行了评估。61%（68/111）的患者存在播散性感染。肝移植受者感染播散性隐球菌病的风险显著高于肝移植受者（校正风险比[HR]， P = 6.65;）。90天总死亡率为14%（16/111）。精神状态异常（P = 0.023）、基线肾衰竭（P = 0.028）、真菌血症（P = 0.006）和播散性感染（P = 0.35）患者的死亡率较高，而接受钙调磷酸酶抑制剂治疗的患者死亡率较低（P = 0.003）。在一项多变量分析中，接受钙调磷酸酶抑制剂与较低的死亡率（校正风险比，0.21;P = 0.008）和基线时肾功能衰竭与较高的死亡率（校正风险比，3.14;P = 0.37）独立相关。因此，隐球菌病移植受者的预后似乎受到所使用的免疫抑制剂类型的影响。此外，识别移植类型特异性疾病严重程度差异的基础，对于进一步深入了解移植受者新生梭状芽胞杆菌感染的发病机制具有重要意义。
Variables influencing the risk of dissemination and outcome of Cryptococcus neoformans infection were assessed in 111 organ transplant recipients with cryptococcosis in a prospective, multicenter, international study. Sixty-one percent ( 68/111) of the patients had disseminated infection. The risk of disseminated cryptococcosis was significantly higher for liver transplant recipients ( adjusted hazard ratio [ HR], P = 6.65;). The overall mortality rate at 90 days was 14% ( 16/111). The mortality rate was higher in patients with abnormal mental status (P = .023), renal failure at baseline (P = .028), fungemia (P = .006), and disseminated infection (P = 0.35) and was lower in those receiving a calcineurin-inhibitor agent (P = .003). In a multivariable analysis, the receipt of a calcineurin-inhibitor agent was independently associated with a lower mortality ( adjusted HR, 0.21; P = .008), and renal failure at baseline with a higher mortality rate ( adjusted HR, 3.14; P = 0.37). Thus, outcome in transplant recipients with cryptococcosis appears to be influenced by the type of immunosuppressive agent employed. Additionally, discerning the basis for transplant type-specific differences in disease severity has implications relevant for yielding further insights into the pathogenesis of C. neoformans infection in transplant recipients.