Background: Whether outcome of central nervous system (CNS) cryptococcosis in solid organ transplant recipients treated with lipid formulations of amphotericin B is different from the outcome of the condition treated with amphotericin B deoxycholate (AmBd) is not known. Methods: We performed a multicenter study involving a cohort comprising consecutive solid organ transplant recipients with CNS cryptococcosis. Results: Of 75 patients treated with polyenes as induction regimens, 55 (73.3%) received lipid formulations of amphotericin B and 20 (26.7%) received AmBd. Similar proportions of patients in both groups had renal failure at baseline ( P=.94). Overall, mortality at 90 days was 10.9% in the group that received lipid formulations of amphotericin B and 40.0% in the group that received AmBd. In univariate analysis, nonreceipt of calcineurin inhibitors (Pp.034), renal failure at baseline (P=.016), and fungemia (P=.003) were significantly associated with mortality. Compared with AmBd, lipid formulations of amphotericin B were associated with a lower mortality (P=.007). Mortality did not differ between patients receiving lipid formulations of amphotericin B with or without flucytosine (P=.349). In stepwise logistic regression analysis, renal failure at baseline (odds ratio [OR], 4.61; 95% confidence interval [CI], 1.02-20.80; P=.047) and fungemia (OR, 10.66; 95% CI, 2.08-54.55; P= .004) were associated with an increased mortality, whereas lipid formulations of amphotericin B were associated with a lower mortality (OR, 0.11; 95% CI, 0.02-0.57; Pp.008). Conclusions: Lipid formulations of amphotericin B were independently associated with better outcome and may be considered as the first-line treatment for CNS cryptococcosis in these patients.
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Potential conflicts of interest. B.D.A. has received grant/research support from Astellas, Pfizer, Enzon, and has served on consultant/advisory boards for Enzon, Pfizer, Schering-Plough, Basilea, and Abbott Diagnostics. O.L. has received research support from Astellas. G.F. has received research support from Astellas. G.M.L. has received research support and honoraria and/or has consulted for Astellas, Merck, Pfizer, and Schering-Plough. L.J. has served on the speaker’s bureau of Pfizer. N.S. has received grant support from Schering-Plough and Pfizer. All other authors: no conflicts.