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Cryptococcosis in Liver Transplant Candidates and Recipients

  • Fungal Infections in Transplantation (S Shoham, Section Editor)
  • Published:
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Abstract

Purpose of Review

Evaluate the epidemiology, risk factors, pathophysiology, and clinical outcomes of cryptococcal infections in patients with advanced liver disease or liver transplantation.

Recent Findings

Cryptococcal infections in patients with advanced liver disease (ALD) are uncommon but associated with high mortality. Less than 10% of patients in a prospective study of non-HIV-infected cryptococcal meningitis patients had ALD. Significantly, fever was uncommon, resulting in delays in diagnosis. Modalities for diagnosing cryptococcal infections include the rapid lateral flow cryptococcal antigen (CrAg) assay from serum and cerebrospinal fluid (CSF) specimens and multiplex polymerase chain reactions from CSF. Screening all ALD patients with CrAg has not been beneficial.

Summary

Cryptococcal infections in patients with ALD and liver transplantation result in poor outcomes due to diagnostic delays and concomitant impaired liver function with hepatotoxic therapies. A high index of suspicion is necessary as routine screening has very low yield for early detection.

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Authors and Affiliations

  1. Division of Infectious Diseases, Oregon Health and Science University, L-457, 3181 SW Sam Jackson Rd, Portland, OR, 97239, USA

    Sara Gore & Graeme N. Forrest

  2. VA Portland Healthcare System, Portland, OR, USA

    Graeme N. Forrest

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Gore, S., Forrest, G.N. Cryptococcosis in Liver Transplant Candidates and Recipients. Curr Fungal Infect Rep 14, 289–298 (2020). https://doi.org/10.1007/s12281-020-00399-y

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