High Mortality and Associated Risk Factors in Kidney Transplant Recipients With Cryptococcosis-A Nationwide Cohort Study Over a Decade Using USRDS Data.

Background: Cryptococcosis is an invasive fungal disease that significantly contributes to morbidity and mortality among kidney transplant recipients (KTRs). Although various prognostic factors predictive of mortality have been identified, most research has been limited to single-center and small-scale studies. Methods: We conducted a retrospective cohort study using data from the United States Renal Data System to investigate hospitalizations and outcomes for cryptococcosis among KTRs in the United States from 2006 to 2016. Collected data included demographics, comorbid conditions, hospitalization- and transplant-related complications, and mortality. Results: A total of 1265 KTRs were hospitalized for cryptococcosis. The mean age was 59.1 ± 11.2 years; 857 (67.7%) were male, 852 (67.4%) were White, 603 (47.7%) resided in the South, and 648 (51.2%) had a diagnosis of cryptococcal meningitis (CM). The overall 6-month mortality rate was 22%. Multivariable logistic regression analyses identified several factors associated with increased 6-month mortality: cirrhosis (adjusted odds ratio [aOR], 3.1; 95% CI, 1.2-7.7), intensive care unit admission (aOR, 2.9; 95% CI, 2.0-4.0), need for pretransplant dialysis (aOR, 2.7; 95% CI, 1.5-4.9), lack of tacrolimus use at follow-up (aOR, 2.2; 95% CI, 1.4-3.3), age ≥60 years (aOR, 2.0; 95% CI, 1.4-2.8), acute kidney injury (aOR, 1.7; 95% CI, 1.2-2.4), post-transplant period exceeding 2 years (aOR, 1.7; 95% CI, 1.1-2.4), and previous hospitalization for complications related to the transplanted kidney (aOR, 1.5; 95% CI, 1.1-2.2). Conclusions: Early mortality remains high among KTRs hospitalized for cryptococcosis, with cirrhosis identified as the strongest independent risk factor for mortality.