Identifying predictors of central nervous system disease in solid organ transplant recipients with cryptococcosis

Transplantation. 2010 Jan 15;89(1):69-74. doi: 10.1097/TP.0b013e3181bcda41.


Background: Cerebrospinal fluid (CSF) analysis is often deferred in patients with cryptococcal disease, particularly in the absence of neurologic manifestations. We sought to determine whether a subset of solid organ transplant (SOT) recipients with high likelihood of central nervous system (CNS) disease could be identified in whom CSF analysis must be performed.

Methods: Patients comprised a multicenter cohort of SOT recipients with cryptococcosis.

Results: Of 129 (88%) of 146 SOT recipients with cryptococcosis who underwent CSF analysis, 80 (62%) had CNS disease. In the overall study population, abnormal mental status, time to onset of cryptococcosis more than 24 months posttransplantation (late-onset disease), serum cryptococcal antigen titer more than 1:64, and fungemia were independently associated with an increased risk of CNS disease. Of patients with abnormal mental status, 95% had CNS cryptococcosis. When only patients with normal mental status were considered, three predictors (serum antigen titer >1:64, fungemia, and late-onset disease) independently identified patients with CNS cryptococcosis; the risk of CNS disease was 14% if none, 39% if one, and 94% if two of the aforementioned predictors existed (chi for trend P<0.001).

Conclusions: CSF analysis should be strongly considered in SOT recipients with cryptococcosis who have late-onset disease, fungemia, or serum cryptococcal antigen titer more than 1:64 even in the presence of normal mental status.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antigens, Fungal / blood
  • Central Nervous System Diseases / epidemiology*
  • Chi-Square Distribution
  • Cohort Studies
  • Cryptococcosis / complications
  • Cryptococcosis / epidemiology*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Likelihood Functions
  • Male
  • Middle Aged
  • Organ Transplantation / adverse effects*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / microbiology
  • Predictive Value of Tests
  • Prospective Studies
  • Regression Analysis


  • Antigens, Fungal
  • Immunosuppressive Agents