Cryptococcosis in kidney transplant recipients in a Chinese university hospital and a review of published cases.

BACKGROUND: Cryptococcosis is a severe fungal infection with a high mortality rate among solid-organ transplant recipients. Today, China is among the countries performing the most kidney transplants worldwide, however data on the association of cryptococcosis with kidney transplantation in mainland China remain scarce and fragmented. METHODS: We retrospectively analyzed cases of culture-confirmed cryptococcosis following kidney transplantation that have occurred at our hospital and reviewed the published cases in China over the last 30 years. RESULTS: Cryptococcosis in kidney transplant recipients was mainly caused by Cryptococcus neoformans var. grubii VNI strains and occurred most frequently in patients aged 41-50 years (37.9%, 11/29). The average time to infection after kidney transplantation was 5.16 ± 3.97 years. The clinical manifestations were found to be diverse, with slight to moderate headache and fever, meningeal irritation, and high cerebrospinal fluid pressure being relatively common. Physicians should be alert to these symptoms among kidney transplant recipients. CONCLUSIONS: Cryptococcosis is a serious infection among kidney transplant recipients in mainland China. It has unique characteristics, such as a relatively long time to onset after kidney transplantation, and diverse clinical manifestations. Treatment with intrathecal injection of amphotericin B is considered effective for central nervous system involvement. The findings of this study also highlight the urgent need for multicenter, prospective, and multidisciplinary clinical studies and education on cryptococcosis in kidney transplant recipients in China.

En bloc kidneys transplanted from infant donors less than 5 kg into pediatric recipients.

BACKGROUND: Given the shortage of donor kidneys, the use of grafts from deceased infant donors is a potential approach to expand the donor pool. Four infant en bloc kidney transplants in pediatric recipients were reported, performed between 2012 and 2013 in the center. METHODS: The en bloc graft was implanted extraperitoneally in the right iliac fossa. The distal end of the donor aorta was anastomosed end-to-end to the internal iliac artery, while the donor vena cava was anastomosed (end-to-side) to the external iliac vein. Both ureters were anastomosed individually to the bladder, with the exception of one case in which a donor bladder patch was anastomosed to the bladder. After the operation, the recipients received basiliximab as induction therapy followed by tacrolimus and mycophenolic acid for immunosuppression. Prophylactic anticoagulation was used postoperatively. RESULTS: Recipients included two girls and two boys with age ranging from 4.6 to 11.6 years. Donor age ranged from 33 to 56 days with weight ranging from 2.5 to 5.0 kg. After a follow-up of 2 to 14 months, patient and graft survivals were 100% and 75%, respectively. Complications included delayed graft function in one patient, urine leak in one, and anticoagulation-related hemorrhage in one. One graft was lost early from vascular thrombosis. The remaining three recipients had excellent graft function with median serum creatinine of 1.1 mg/dL (range, 0.8-1.3 mg/dL) at last follow-up. CONCLUSIONS: Promising outcomes can be obtained from en bloc transplantation from infant donors. The use of this donor population for pediatric recipients should be encouraged.