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Published on: May 2, 2013
Prevention of fungal infection in transplantation
1Mayo Clinic, Bldg 501, Rochester, MN 55905, USA. paya@mayo.edu
Abstract:
Despite significant advances in the diagnosis, prevention, and treatment of fungal infection in transplant recipients, this infection complication remains a major cause of morbidity and mortality. Our understanding of the pathogenesis of the different fungal microorganisms has enabled us to identify patients at risk for such infections. While Candida infection remains a major complication in patients with intra-abdominal solid organ transplantations in which the bowel is surgically manipulated, Aspergillus infection remains the main fungal complication in lung transplantation recipients. The incidence of all types of fungal infection remains around 5-10%, while mortality following Aspergillus infection remains around 70%. Suppression of Candida growth at the time of surgical manipulation of the bowel should be the mainstay of prevention of this infection in intra-abdominal organ transplantation. Fluconazole is effective and relatively safe at 100-400 mg daily for the first 1-3 months post-liver transplantation. Prevention strategies toward Aspergillus infections remain elusive, but a number of manipulations, such as inhaled liposomal preparations post-organ transplantation or the preemptive use or universal prophylaxis of itraconazole are being validated. The next step is to determine the clinical value of molecular diagnostic techniques for the identification and preemptive therapy of patients at risk for the variety fungal infections.
Insights
Fungal infections in transplant recipients, particularly Candida and Aspergillus, cause significant morbidity and mortality. Early diagnosis and targeted prevention strategies are crucial for improving outcomes in these vulnerable patients.
Area of Science:
- Transplant Infectious Diseases
- Mycology
- Immunocompromised Host Infections
Background:
- Fungal infections are a significant cause of morbidity and mortality in transplant recipients despite advances in care.
- Understanding fungal pathogenesis aids in identifying at-risk patients.
- Candida infections complicate intra-abdominal transplants, while Aspergillus infections are prevalent in lung transplant recipients.
Purpose of the Study:
- To review current understanding and management of fungal infections in organ transplant recipients.
- To highlight specific fungal pathogens and their associated transplant types.
- To discuss current and emerging prevention strategies for fungal infections.
Main Methods:
- Review of existing literature on fungal infections in transplant recipients.
- Analysis of incidence and mortality rates for specific fungal infections.
- Evaluation of current and investigational prevention and treatment strategies.
Main Results:
- Fungal infections occur in 5-10% of transplant recipients, with high mortality, especially for Aspergillus infections (around 70%).
- Candida prevention involves suppressing growth during bowel manipulation in abdominal transplants; fluconazole is recommended post-liver transplant.
- Aspergillus prevention strategies are evolving, including inhaled liposomal preparations and itraconazole prophylaxis.
Conclusions:
- Targeted prevention of Candida and Aspergillus infections is essential for improving transplant recipient outcomes.
- Molecular diagnostics hold promise for early identification and preemptive therapy of fungal infections.
- Further research is needed to validate novel prevention and diagnostic approaches.
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