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October 1969

Successful Renal Allograft in a Patient With Pulmonary Cryptococcus

Arch Intern Med. 1969;124(4):502-506. doi:10.1001/archinte.1969.00300200114019

Infectiong factor in renal allograft transplantation.1 Mortality has decreased as the technical aspects of surgery have been mastered, as knowledge of posttransplant physiology has accumulated,2 and as management of immunologic sequelae has improved.3 Death in the first weeks after transplant is largely attributable to conventional postoperative complications (cardiac failure, myocardial infarction, hemorrhage, or pulmonary emboli). Renal failure is an uncommon source of mortality.1 Infection is a continuing source of mortality, with unusual microorganisms predominating, eg, Pseudomonas and other gram negative organisms, Pneumocystis carinii, cytomegalovirus, and fungi.

In one series, 38 of 44 patients dying 24 days or later after transplantation succumbed to infection.1 In this group, 45% of the deaths were due to infection with fungi.4 Fungal infections have included both primary pathogens (Nocardia, Histo-plasma) and commonly occurring saprophytes (Aspergillus, Candida).4 The source of these pathogens could be a newly acquired infection,