Prophylactic antifungal agents used after lung transplantation

Area of Science:

• Immunology
• Infectious Diseases
• Transplant Surgery

Background:

• Invasive fungal infections (IFIs) are a significant cause of mortality following lung transplantation.
• The lung is uniquely susceptible to IFIs due to its role in gas exchange and direct exposure to airborne pathogens.
• Candida and Aspergillus species are common culprits, typically manifesting within the first year post-transplant.

Purpose of the Study:

• To review existing data on antifungal agents for preventing fungal infections in lung transplant recipients.
• To compare different prophylactic regimens used in this patient population.

Main Methods:

• A comprehensive literature search was conducted using MEDLINE and the United Network for Organ Sharing database.
• Articles and abstracts in English concerning adult lung transplant recipients receiving systemic antifungal prophylaxis were evaluated.
• Reference citations from identified publications were also reviewed.

Main Results:

• Despite an increase in lung transplants, no standardized antifungal prophylactic regimen is established.
• Literature on antifungal prophylaxis for lung transplant recipients is limited, potentially due to varying center protocols.
• Aerosolized amphotericin B and azole antifungals were most frequently described, showing a reduced risk of IFIs.
• Initiating some form of antifungal prophylaxis is now standard practice.

Conclusions:

• Fungal infection risk after lung transplantation is multifactorial.
• Optimal prophylactic strategies should target the most prevalent and pathogenic fungi effectively.