scholarly journals A Retrospective Analysis of Pulmonary Cryptococcosis Following Kidney Transplantation: Clinical Presentation, Treatment and Effectiveness

Shuyang CHEN ◽  
Meiyan CHEN ◽  
Lei GU ◽  
Qing WANG ◽  
Yanjing YOU ◽  

Abstract Background: The use of immunosuppressors and a relatively weaken cell-mediated immunity make organ transplant recipients particularly vulnerable to cryptococcosis infection. Patients infected usually present only nonspecific symptoms, making it extremely possible for misdiagnosis and inappropriate choice of therapeutic approach. Methods: We compiled and analysed data of patients received kidney transplant in our hospital between April 2006 to January 2021. Results: 18 patients were enrolled into the study, ranging between 27-68 years old. The median time from kidney transplantation to pathologically-confirmed infection was 4.09 years. All patient’s respiratory system was affected, showing symptoms including sputum-producing cough and fever. 3 patients (16.67%) also developed central nervous system (CNS) infections. Nodule-shaped infectious sites were frequently observed (10, 58.82%) in chest CT. Blood works showed no specific changes. 7 patients received thoracoscopic lobectomy in suspicion of lung cancer. 3 patients first received antifungal therapy for a period of time and then underwent thoracoscopic lobectomy. No recurrence whatsoever was observed in all 10 surgically-intervened patients. 8 patients received only antifungal therapy, 7 of them showed a substantial reduction in the size of the infectious site. Fluconazole was most frequently prescribed for antifungal therapy. Conclusion: Most patients developed pulmonary cryptococcosis 2 years after transplantation. Patients usually demonstrate symptoms like fever and sputum-producing cough. The possibility of cryptococcal meningitis shouldn’t be ruled out if corresponding symptoms occur. CT presentation may be confused with lung cancer. Fluconazole is commonly prescribed for treatment and can usually yield satisfied outcome. In patients received unsatisfactory antifungal therapy, surgical therapy should be considered a possibility.

Lung Cancer ◽  
2020 ◽  
Vol 147 ◽  
pp. 214-220
Kelvin Young ◽  
Haiyan Jiang ◽  
Max Marquez ◽  
Jonathan Yeung ◽  
Frances A. Shepherd ◽  

2015 ◽  
Vol 99 (10) ◽  
pp. 2181-2189 ◽  
Keith Sigel ◽  
Rajwanth Veluswamy ◽  
Katherine Krauskopf ◽  
Anita Mehrotra ◽  
Grace Mhango ◽  

2021 ◽  
Jackrapong Bruminhent ◽  
Chavachol Sethaudom ◽  
Pongsathon Chaumdee ◽  
Sarinya Boongird ◽  
Sasisopin Kiertiburanakul ◽  

Immunogenicity following inactivated SARS-CoV-2 vaccination among solid organ transplant recipients has not been assessed. Seventy-five patients (37 kidney transplant [KT] recipients and 38 non-transplant controls) received two doses, at 4-week intervals, of an inactivated whole-virus SARS-CoV-2 vaccine. SARS-CoV-2-specific humoral (HMI) and cell-mediated immunity (CMI) were measured before, 4 weeks post-first dose, and 2 weeks post-second dose. The median age of KT recipients was 50 years (IQR, 42 to 54) and 89% were receiving calcineurin inhibitors/mycophenolate/corticosteroid regimens. The median time since transplant was 4.5 years (IQR, 2 to 9.5). Among 35 KT patients, anti-RBD IgG titer after vaccination was not significantly different to baseline, but was significantly lower than in controls (7.8 [95%CI 0.2 to 15.5] vs 2,691 [95%CI 1,581 to 3,802], p<0.001) as well as the percentage of surrogate virus neutralizing antibody inhibition (2 [95% CI -1 to 6] vs 71 [95%CI 61 to 81], p<0.001). However, the mean of SARS-CoV-2 mixed peptides-specific T-cell responses measured by enzyme-linked immunospot assays was significantly increased compared with baseline (66 [95%CI 36 to 99] vs. 34 [95%CI 19 to 50] T-cells/10^6 PBMCs, p=0.02) and comparable to that in controls. Our findings revealed weak HMI and marginal CMI responses in fully vaccinated KT recipients receiving inactivated SARS-CoV-2 vaccine. (Thai Clinical Trials Registry, TCTR20210226002).

Viruses ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 1879
Dominika Dęborska-Materkowska ◽  
Dorota Kamińska

Since its outbreak in December 2019, the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to an enormous rise in scientific response with an excess of COVID-19-related studies on the pathogenesis and potential therapeutic approaches. Solid organ transplant (SOT) recipients are a heterogeneous population with long-lasting immunosuppression as a joining element. Immunocompromised patients are a vulnerable population with a high risk of severe infections and an increased infection-related mortality rate. It was postulated that the hyperinflammatory state due to cytokine release syndrome during severe COVID-19 could be alleviated by immunosuppressive therapy in SOT patients. On the other hand, it was previously established that T cell-mediated immunity, which is significantly weakened in SOT recipients, is the main component of antiviral immune responses. In this paper, we present the current state of science on COVID-19 immunology in relation to solid organ transplantation with prospective therapeutic and vaccination strategies in this population.

2005 ◽  
Vol 360 (1461) ◽  
pp. 1739-1746 ◽  
Stuart J Knechtle

The study of tolerance in the clinic can be divided into three areas: (i) focused evaluation of existing tolerant transplant recipients as to their mechanism of tolerance; (ii) prospective tolerance trials, such as combined bone marrow and kidney transplantation as well as T cell depletion followed by subsequent weaning of immunosuppression; and (iii) immunologic assays to assess the likelihood of rejection or tolerance. Frankly, a very small number of patients have been transplanted with the intention of removing all immunosuppressive therapy, but several clinical trials with this aim are currently in progress, largely sponsored by the Immune Tolerance Network, a joint venture between the National Institutes of Health and the Juvenile Diabetes Research Foundation. Similarly, a reliable assay to assess tolerance has not yet been developed but a variety of approaches towards assessing rejection, and in some cases tolerance, are being developed. It would be accurate to state that many of the experimental and preclinical approaches to the induction of tolerance have resulted in better immunosuppression for human transplantation, but reliable tolerance strategies in humans have not yet been achieved. Combined bone marrow and kidney transplantation may be considered as one exception to this, but such a strategy is not generally applicable to the vast majority of solid organ transplant recipients. This review will summarize efforts to date, particularly focusing on kidney transplantation.

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