{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T13:50:08Z","timestamp":1776261008109,"version":"3.50.1"},"reference-count":57,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,5,30]],"date-time":"2018-05-30T00:00:00Z","timestamp":1527638400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"National Council of Technological and Scientific Development","award":["CNPq 132513\/2005-6"],"award-info":[{"award-number":["CNPq 132513\/2005-6"]}]},{"name":"National Council of Technological and Scientific Development","award":["CNPq 307510\/2015-8"],"award-info":[{"award-number":["CNPq 307510\/2015-8"]}]},{"name":"Public Health Service Grants","award":["AI73896"],"award-info":[{"award-number":["AI73896"]}]},{"name":"Public Health Service Grants","award":["AI04533"],"award-info":[{"award-number":["AI04533"]}]},{"name":"Public Health Service Grants","award":["AI93257"],"award-info":[{"award-number":["AI93257"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cryptococcosis is the second most common cause of invasive fungal infections in renal transplant recipients in many countries, and data on graft outcome after treatment for this infection is lacking in less\u2010resourced health care settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from 47 renal transplant recipients were retrospectively collected at a single institution during a period of 13\u00a0years. Graft dysfunction, graft loss, and mortality rates were evaluated. Predictors of mortality and graft loss were estimated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 38 (97.4%) patients treated with amphotericin B deoxycholate (<jats:styled-content style=\"fixed-case\">AMB<\/jats:styled-content>d) showed graft dysfunction after antifungal initiation and 8 (18.2%) had kidney graft loss. Graft loss within 30\u00a0days after cryptococcosis onset was significantly associated with disseminated infection, greater baseline creatinine levels, and graft dysfunction concomitant to <jats:styled-content style=\"fixed-case\">AMB<\/jats:styled-content>d therapy and an additional nephrotoxic condition. The 30\u2010day mortality rate was 19.2% and it was significantly associated with disseminated and pulmonary infections, somnolence at admission, high <jats:styled-content style=\"fixed-case\">CSF<\/jats:styled-content> opening pressure, positive <jats:styled-content style=\"fixed-case\">CSF<\/jats:styled-content> India ink, creatinine levels greater than 2.0\u00a0mg\/<jats:styled-content style=\"fixed-case\">dL<\/jats:styled-content> at admission, graft dysfunction in patients treated with <jats:styled-content style=\"fixed-case\">AMB<\/jats:styled-content>d and an additional nephrotoxic condition and graft loss within 30\u00a0days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Graft dysfunction was common in renal transplant recipients with cryptococcosis treated with <jats:styled-content style=\"fixed-case\">AMB<\/jats:styled-content>d. The rate of graft loss rate was high, most frequently in patients with concomitant nephrotoxic conditions. Therefore, the clinical focus should be on the use of less nephrotoxic lipid formulations of amphotericin B in this specific population requiring a polyene induction regimen for treatment of severe cryptococcosis in all health care systems caring for transplantation recipients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.12910","type":"journal-article","created":{"date-parts":[[2018,4,20]],"date-time":"2018-04-20T16:16:08Z","timestamp":1524240968000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Outcomes of cryptococcosis in renal transplant recipients in a less\u2010resourced health care system"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2991-3084","authenticated-orcid":false,"given":"Vinicius","family":"Ponzio","sequence":"first","affiliation":[{"name":"Department of Medicine Division of Infectious Diseases Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Fernando","family":"Camargo","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Infectious Diseases Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9","family":"Medina\u2010Pestana","sequence":"additional","affiliation":[{"name":"Discipline of Nephrology Hospital do Rim Oswaldo Ramos Foundation Universidade Federal de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Robert","family":"Perfect","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine Duke University School of Medicine  Durham NC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnaldo Lopes","family":"Colombo","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Infectious Diseases Escola Paulista de Medicina Universidade Federal de S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,5,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1128\/mSphere.00357-16"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2015.10.006"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-197104000-00018"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/81.2.272"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-199605000-00004"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1086\/314606"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/322597"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1128\/CMR.8.4.515","article-title":"Cryptococcosis in the era of AIDS\u2013100\u00a0years after the discovery of Cryptococcus neoformans","volume":"8","author":"Mitchell TG","year":"1995","journal-title":"Clin Microbiol Rev"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199803263381301"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkh438"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1086\/368091"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200402200-00024"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1439-0507.2004.01082.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0040021"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0043582"},{"key":"e_1_2_9_17_1","first-page":"162","article-title":"Infec\u00e7\u00e3o por fungos e transplante renal: an\u00e1lise nos primeiros 500 pacientes transplantados no Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto \u2010 USP","volume":"17","author":"Moys\u00e9s Neto M","year":"1995","journal-title":"J Bras Nefrol"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1086\/651262"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1975.00330090035004"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-200109000-00004"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1432-2277.2003.tb00309.x"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3062.2002.t01-1-02005.x"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid0703.017302"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofx004"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000173774.74388.49"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1086\/649858"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1086\/647948"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0037-86822008000500022"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3062.2000.020302.x"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(87)90691-7"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-282X1988000200002"},{"key":"e_1_2_9_32_1","first-page":"692","article-title":"Successful treatment of invasive fungal infection with fluconazole in organ transplant recipients","volume":"48","author":"Conti DJ","year":"1989","journal-title":"Transplantation"},{"key":"e_1_2_9_33_1","first-page":"1898","article-title":"Cryptococcosis in renal transplant recipients","volume":"24","author":"Shaariah W","year":"1992","journal-title":"Transplant Proc"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/49.suppl_1.57"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1086\/588660"},{"key":"e_1_2_9_36_1","first-page":"169","article-title":"Cure of cryptococcal infection during continued immunosuppressive therapy","volume":"55","author":"Watson AJ","year":"1985","journal-title":"Q J Med"},{"key":"e_1_2_9_37_1","first-page":"3091","article-title":"Protective effect of cyclosporine in human renal posttransplant cryptococcosis","volume":"24","author":"Sampaio M","year":"1992","journal-title":"Transplant Proc"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000061610.34110.04"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.1990.tb00393.x"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199410150-00020"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1086\/653606"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198708063170602"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1086\/319211"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1086\/313498"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1086\/505969"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(89)80612-6"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2001.00948.x"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1413-86702006000200005"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-017-0379-9"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01800-12"},{"key":"e_1_2_9_51_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1093\/ajhp\/61.1.50","article-title":"Changes in renal function after changes in antifungal drug therapy","volume":"61","author":"Klibanov OM","year":"2004","journal-title":"Am J Health Syst Pharm"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1086\/598936"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1086\/592690"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e318236cd1a"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000180530.17683.02"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu711"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1086\/511438"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.6.1865"}],"container-title":["Transplant Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftid.12910","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tid.12910","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T15:53:25Z","timestamp":1694966005000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tid.12910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,30]]},"references-count":57,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,8]]}},"alternative-id":["10.1111\/tid.12910"],"URL":"https:\/\/doi.org\/10.1111\/tid.12910","archive":["Portico"],"relation":{},"ISSN":["1398-2273","1399-3062"],"issn-type":[{"value":"1398-2273","type":"print"},{"value":"1399-3062","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,5,30]]},"assertion":[{"value":"2017-12-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-03-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-30","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e12910"}}