Cryptococcosis in kidney transplant recipients: Pathogenesis, clinical challenges, and evolving therapeutic strategies.

With the widespread use of immunosuppressants and improved post-transplant survival, cryptococcosis has become a consequential opportunistic infection in kidney transplant recipients. This review synthesizes recent advances in epidemiology, pathogenesis, clinical presentation, diagnostics, treatment, and prognosis. Kidney transplant-associated cryptococcosis often presents insidiously, is prone to central nervous system involvement, and carries substantial risks of mortality and allograft loss. The adoption of rapid cryptococcal antigen lateral flow assays, broader access to liposomal amphotericin B, and individualized adjustments of immunosuppression have improved outcomes; however, challenges persist, including relapse, drug toxicities, and immune reconstitution inflammatory syndrome. We summarize current evidence and outline priorities for research and clinical practice, aiming to support timely diagnosis and optimized, phase-based antifungal strategies in this high-risk population.