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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Cryptococcus neoformans infection remains a rare but severe complication in kidney transplant recipients. We report a case of subacute and clinically poor neurological decline revealing cryptococcal meningoencephalitis within the first year post-transplant (<9 months after transplantation), emphasizing the diagnostic difficulty of such infections.
Mortality rates for invasive cryptococcosis range from 33% to 42% in the SOT population, with a typically delayed onset (median ~575 days post-transplant) in most series (Elhaj Mahmoud et al., 2024).
A 71-year-old male received a kidney transplant from a deceased donor. Maintenance immunosuppression included tacrolimus (target trough initially 10–13 ng/mL until day 90, then 7–9 ng/mL), mycophenolate mofetil, and low-dose prednisone.
Post-transplant complications included early chirurgical complication and a CMV infection treated at 5 months post-transplantation.
Approximately 7 months after transplantation, the patient developed, over 2–3 weeks, marked asthenia and anorexia, mild cognitive decline (memory loss, nocturnal episodic hallucinations), gait impairment requiring wheelchair assistance, no fever, and a 10 kg weight loss. Neurological examination showed psychomotor slowing without focal deficit.
Laboratory evaluation revealed less than 30 % increase in usual creatinine level (from ~170 to 221 µmol/L) , hyponatremia (133 mmol/L), lymphopenia (0.8 G/L; WBC ~7 G/L), tacrolimus trough 8.6 ng/mL, and CRP ~1 mg/L. Neuroimaging (non-contrast cranial CT) was unremarkable.
Lumbar puncture revealed clear CSF; India ink preparation demonstrated encapsulated yeasts. Cryptococcal antigen was positive in both CSF and serum with a high titer (>1:2560). Viral PCRs (EBV, CMV, HSV, VZV, JC virus) were negative. MRI showed only fine ventricular wall contrast uptake at the ventricular junctions, consistent with subtle ependymal or meningeal inflammation, without parenchymal lesion.
The infectious diseases and nephrology teams adjusted immunosuppression (mycophenolate suspended, tacrolimus target reduced to 4–6 ng/mL, prednisone increased to 10 mg/day) and initiated antifungal therapy: induction with liposomal amphotericin B (3 mg/kg/day) plus flucytosine (100 mg/kg/day) for 15 days; consolidation with fluconazole 800 mg every 48 h for 8 weeks, followed by maintenance fluconazole 200 mg/day for 6–12 months.
Following antifungal therapy initiation and immunosuppression adjustment, the patient showed gradual regression of neurological symptoms: gait improved, confusion resolved, and only mild episodic memory impairment persisted at discharge.
Renal graft function temporarily worsened during amphotericin B infusion, accompanied by volume overload; this was resolved with diuretic adjustment (furosemide). At one-month follow-up, creatinine was ~182 µmol/L. No relapse of cryptococcal infection and no acute rejection was documented.
For transplant nephrologists, a high index of suspicion is warranted when a SOT patient presents with isolated unexplained neurological signs. The main challenge lies in reconciling antifungal toxicity with graft-protective immunosuppression. Further reporting of such cases is needed to better define optimal immunosuppression strategies and long-term graft outcomes in this context.
