Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France

Laurène Tardieu (1) , Gillian Divard (2, 3) , Olivier Lortholary (4, 5, 6, 7) , Anne Scemla (3) , Éric Rondeau (1) , Isabelle Accoceberry (8) , Rémi Agbonon , Alexandre Alanio (9) , Adela Angoulvant (10) , Laetitia Albano , Philippe Attias , Anne Pauline Bellanger , Dominique Bertrand , Julie Bonhomme , Françoise Botterel , Nicolas Bouvier , Matthias Buchler , Taieb Chouaki , Thomas Crépin , Marie-Fleur Durieux , Guillaume Desoubeaux , Gary Doppelt , Loïc Favennec , Arnaud Fekkar , Ophélie Fourdinier , Marie Frimat , Jean-Pierre Gangneux (11) , Claire Garandeau (12) , Lilia Hasseine , Christophe Hennequin (13) , Xavier Iriart , Nassim Kamar (14) , Hannah Kaminski , Raphael Kormann , Laurence Lachaud (15, 16) , Christophe Legendre , Moglie Le Quintrec Donnette (16) , Jordan Leroy (17) , Charlène Levi , Marie Machouart , David Marx , Jean Menotti , Valérie Moal (18) , Florent Morio (19) , Natacha Mrozek , Muriel Nicolas , Philippe Poirier (20) , Marie-Noelle Peraldi , Benjamin Poussot , Stéphane Ranque (21) , Jean-Philippe Rerolle , Boualem Sendid , Renaud Snanoudj , Jérôme Tourret , Marc Vasse , Cécile Vigneau (22, 11) , Odile Villard , Laurent Mesnard (1) , Fanny Lanternier (7) , Cédric Rafat (1)

1 CHU Tenon [AP-HP]
2 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
3 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
4 Centre d'infectiologie Necker-Pasteur [CHU Necker]
5 Mycologie moléculaire - Molecular Mycology
6 CNRMA - Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals
7 GEMS - Génomique évolutive, modélisation et santé
8 Hôpital Pellegrin
9 Laboratoire de Parasitologie-Mycologie [CHU Saint Louis, Paris]
10 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
11 Irset - Institut de recherche en santé, environnement et travail
12 ITUN - Institut de transplantation urologie-néphrologie
13 CRSA - Centre de Recherche Saint-Antoine
14 Infinity - Institut Toulousain des Maladies Infectieuses et Inflammatoires
15 MIVEGEC - Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle
16 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
17 UGSF - Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576
18 MEPHI - Microbes évolution phylogénie et infections
19 IICiMed - Cibles et Médicaments des Infections et de l'Immunité
20 3IHP - Infection Inflammation et Interaction Hôtes Pathogènes [CHU Clermont-Ferrand]
21 VITROME - Vecteurs - Infections tropicales et méditerranéennes
22 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]

Cryptococcosis is the third most common cause of invasive fungal infection in solid organ transplant recipients and cryptococcal meningitis (CM) its main clinical presentation. CM outcomes, as well as its clinical features and radiological characteristics, have not yet been considered on a large scale in the context of kidney transplantation (KT). We performed a nationwide retrospective study of adult patients diagnosed with cryptococcosis after KT between 2002 and 2020 across 30 clinical centers in France. We sought to describe overall and graft survival based on whether KT patients with cryptococcosis developed CM or not. Clinical indicators of CNS involvement and brain radiological characteristics were assessed. Eighty-eight cases of cryptococcosis were diagnosed during the study period, with 61 (69.3%) cases of CM. Mortality was high (32.8%) at 12 months (M12) but not significantly different whether or not patients presented with CM. Baseline hyponatremia and at least one neurological symptom were independently associated with CM (p < 0.001). Positive serum cryptococcal antigen at diagnosis was also significantly associated with CM (p < 0.001). On magnetic resonance imaging (MRI), three patterns of brain injury were identified: parenchymal, meningeal, and vascular lesions. Although CM does not affect graft function directly, it entails a grim prognosis.

Keywords: Graft outcome; Opportunistic infection; Renal transplantation; Transplant associated diseases; Cryptococcal meningitis; Cryptococcosis

Domains: Microbiology and Parasitology

Laurène Tardieu, Gillian Divard, Olivier Lortholary, Anne Scemla, Éric Rondeau, et al.. Cryptococcal Meningitis in Kidney Transplant Recipients: A Two-Decade Cohort Study in France. Pathogens, 2022, 11 (6), pp.699. ⟨10.3390/pathogens11060699⟩. ⟨hal-03789427⟩