630. Epidemiology of Cryptococcocal Disease (CD) and Cryptococcal Meningitis (CM) in a Large Retrospective Cohort of Solid Organ Transplant (SOT) recipients
Session: Oral Abstract Session: Epidemiology of Transplant Infections
Thursday, October 8, 2015: 3:00 PM
Room: 25--ABC

Background: Cryptococcosis is the third most common invasive fungal infection in SOT recipients with an overall incidence ranging from 0.2% to 5%. There are no nationally representative data describing the incidence, risk factors and outcomes of CD in the SOT population.

Methods:   We assembled a large cohort of adult SOT recipients using ICD-9 CM billing data from HCUP State Inpatient Databases of Florida (2006-2012), New York (2006-2011) and California (2004-2010).  Demographics, comorbidities, CD and CM coded during hospitalization and inpatient death were identified. We used Cox proportional hazard multivariate analyses to identify independent risk factors for CD and death.

Results:  34,383 patients with SOT were identified during the study period. CD was identified in 0.42 % (n=145), of which 47.5% had CM (n=69). Median time to diagnosis of CD was 477 days (IQR 166-858).  42.7 % of CD (n=62) occurred within the first year after transplantation. Risk factors for CD were diabetes (hazard ratio (HR), 1.8; 95% confidence interval [CI], 1.30-2.54), lymphopenia (HR 3.25 CI, 1.33-7.96) and lung transplantation (HR 2.43 CI, 1.41-4.17).  CD was independently associated with death (HR, 4.2; 95% CI, 3.0.-5.9) after adjusting for diabetes (HR 1.27 CI, 1.18-1.37), hematological malignancies (HR 1.54 CI, 1.17-2.04), cirrhosis (HR 1.13 CI, 1.01-1.27), transplant failure/rejection (HR 3.26 CI, 2.95-3.60) and lung transplantation (HR 1.64 CI, 1.43-1.87).

Conclusion: Cryptococcal disease is a rare but deadly infectious complication in SOT recipients.  Increasing age, diabetes, and lymphopenia and lung transplants are risk factors for CD.

Table Risk Factors for Cryptococcal Disease and Death

 

HR ( CI) for CD

HR(CI) for death

Age in years

   18-40

   41-50

   51-60

   61-70

   >70

1.00

2.03(1.10-3.74)

1.17(0.95-3.10)

2.21(1.21-4.01)

2.55(1.11-5.83)

1.00

1.33(1.15-1.55)

1.67(1.46-1.91)

2.33(2.04-2.67)

3.86(2.73-3.72)

Diabetes

1.82(1.30-2.54)

1.27(1.18-1.37)

Lymphopenia

3.25(1.33-7.96)

 

Lung Transplant

Hematological Malignancies

Cirrhosis

Transplant failure/rejection

Cryptococcal disease

 

2.43(1.41-4.17)

1.64(1.43-1.87)

1.54(1.17-2.04)

1.13(1.01-1.27)

3.26(2.95-3.60)

4.24(3.03-5.93)

 

Ige George, MD1, Carlos Santos, MD2, William Powderly, MD, FIDSA3 and Margaret a. Olsen, PhD, MPH2, (1)Infectious Disease, Washington University School of Medicine, St Louis, MO, (2)Medicine, Washington University School of Medicine, St. Louis, MO, (3)Infectious Diseases, Washington University School of Medicine, Saint Louis, MO

Disclosures:

I. George, None

C. Santos, None

W. Powderly, None

M. A. Olsen, None

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