[Prophylaxis against fungal infections in solid organ and hematopoietic stem cells transplantation]

Area of Science:

• Transplant Medicine
• Infectious Diseases
• Mycology

Background:

• Invasive fungal infections (IFIs) are a major cause of illness and death in solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients.
• Candida and Aspergillus species are the most common culprits, often occurring within six months post-transplant, but also later during rejection episodes.
• Immune suppression in transplant recipients significantly increases susceptibility to IFIs.

Purpose of the Study:

• To review current prophylaxis recommendations for IFIs in SOT and HSCT recipients.
• To highlight variations in guidelines based on transplant type, patient population (adult vs. pediatric), and specific fungal risks.
• To identify gaps in evidence, particularly for pediatric populations.

Main Methods:

• Review of existing prophylaxis guidelines and recommendations for IFIs in SOT and HSCT.
• Analysis of specific antifungal agents and their suggested use in different transplant scenarios.
• Comparison of recommendations for adult and pediatric populations.

Main Results:

• Prophylaxis strategies differ significantly across transplant types (liver, lung, HSCT).
• Liver transplant recipients: Fluconazole for high-risk cases; amphotericin B or caspofungin suggested for aspergillosis risk in adults, unvalidated in pediatrics.
• Lung transplant recipients: Universal prophylaxis with itraconazole, nebulized liposomal amphotericin B, or voriconazole recommended for adults; no pediatric validation.
• HSCT recipients: Universal prophylaxis in selected allogeneic/autologous cases; fluconazole, posaconazole, or micafungin for high aspergillosis risk.

Conclusions:

• IFIs remain a critical concern in transplant recipients, necessitating tailored prophylaxis.
• Existing guidelines show considerable variation, with a notable lack of validated recommendations for pediatric populations.
• Further research is needed to establish evidence-based prophylaxis strategies for allogeneic and autologous HSCT and pediatric transplant recipients.