Unrecognized pretransplant and donor‐derived cryptococcal disease in organ transplant recipients.

BACKGROUND: Cryptococcosis occurring ≤30 days after transplantation is an unusual event, and its characteristics are not known. METHODS: Patients included 175 solid-organ transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days after transplantation, respectively. RESULTS: Very early-onset disease developed in 9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6% (5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of the patients with late-onset disease were liver transplant recipients (P = .05). Very early cases were more likely to present with disease at unusual locations, including transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001). Two very early cases with onset on day 1 after transplantation (in a liver transplant recipient with Cryptococcus isolated from the lung and a heart transplant recipient with fungemia) likely were the result of undetected pretransplant disease. An additional 5 cases involving the allograft or surgical sites were likely the result of donor‐acquired infection. CONCLUSIONS: A subset of SOT recipients with cryptococcosis present very early after transplantation with disease that appears to occur preferentially in liver transplant recipients and involves unusual sites, such as the transplanted organ or the surgical site. These patients may have unrecognized pretransplant or donor-derived cryptococcosis.

The abelianization of the Johnson kernel

We prove that the first complex homology of the Johnson subgroup of the Torelli group Tg is a non-trivial, unipotent Tg-module for all g ≥ 4 and give an explicit presentation of it as a Sym H 1(Tg,C)-module when g ≥ 6. We do this by proving that, for a finitely generated group G satisfying an assumption close to formality, the triviality of the restricted characteristic variety implies that the first homology of its Johnson kernel is a nilpotent module over the corresponding Laurent polynomial ring, isomorphic to the infinitesimal Alexander invariant of the associated graded Lie algebra of G. In this setup, we also obtain a precise nilpotence test. © European Mathematical Society 2014.