Invasive Fungal Infections in Solid Organ Transplant Recipients

Shmuel Shoham; Kieren A Marr

Disclosures

Future Microbiol. 2012;7(5):639-655. 

In This Article

Abstract and Introduction

Abstract

Invasive fungal infections are a major problem in solid organ transplant (SOT) recipients. Overall, the most common fungal infection in SOT is candidiasis, followed by aspergillosis and cryptococcosis, except in lung transplant recipients, where aspergillosis is most common. Development of invasive disease hinges on the interplay between host factors (e.g., integrity of anatomical barriers, innate and acquired immunity) and fungal factors (e.g., exposure, virulence and resistance to prophylaxis). In this article, we describe the epidemiology and clinical features of the most common fungal infections in organ transplantation. Within this context, we review recent advances in diagnostic modalities and antifungal chemotherapy, and their impact on evolving prophylaxis and treatment paradigms.

Introduction

Improvements in therapeutic and diagnostic options are providing clinicians with unprecedented tools to evaluate, manage and prevent invasive fungal infection in solid organ transplant (SOT) recipients. Despite these advances, invasive fungal infections continue to be a major cause of morbidity and mortality in this population. Recent studies have shed new light on the epidemiology of invasive fungal infections in SOT recipients.[1–3] The overall cumulative incidence during the first year after transplantation is approximately 3%, although this varies depending on the type of organ transplanted.[1] However, the risk of infection, particularly due to inhaled fungi, persists for many years after transplant. Current epidemiological trends indicate a shift towards later infections. The consequences of fungal infection can be dire and include long hospitalizations, allograft damage and high mortality rates. Data from 15 centers involved in a prospective cohort study of invasive fungal infections in SOT recipients indicate that mortality at 12 months is approximately 40% for aspergillosis, 34% for candidiasis and 27% for cryptococcosis.[1] In this article, we review the epidemiology, clinical presentations, diagnostic techniques and therapeutic options for the most common invasive fungal infection in SOT recipients.

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