Related Experiment Video
Updated: Jul 1, 2025
Passive Administration of Monoclonal Antibodies Against H. capsulatum and Others Fungal Pathogens
Published on: February 14, 2011
Pharmacological management of invasive mold infections in solid organ transplant recipients
Mario Fernández-Ruiz1,2,3
1Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.
Introduction:
Solid organ transplant (SOT) recipients face an increased susceptibility to invasive fungal infection (IFI) due to filamentous fungi. Post-transplant invasive aspergillosis (IA) and mucormycosis are related to exceedingly high mortality rates and graft loss risk, and its management involve a unique range of clinical challenges.
Areas Covered:
First, the current treatment recommendations for IA and mucormycosis among SOT recipients are critically reviewed, including the supporting evidence. Next, we discussed particular concerns in this patient population, such as drug-drug interactions (DDIs) between triazoles and post-transplant immunosuppression or treatment-related toxicity. The role for immunomodulatory and host-targeted therapies is also considered, as well as the theoretical impact of the intrinsic antifungal activity of calcineurin inhibitors. Finally, a personal opinion is made on future directions in the pharmacological approach to post-transplant IFI.
Expert Opinion:
Despite relevant advances in the treatment of mold IFIs in the SOT setting, such as the incorporation of isavuconazole (with lower incidence of DDIs and better tolerability than voriconazole), there remains a large room for improvement in areas such as the position of combination therapy or the optimal strategy for the reduction of baseline immunosuppression. Importantly, future studies should define the specific contribution of newer antifungal agents and classes.
Insights
Solid organ transplant recipients are vulnerable to invasive fungal infections like aspergillosis and mucormycosis. Current treatments are reviewed, highlighting challenges and future directions for managing these serious post-transplant infections.
Area of Science:
- Mycology
- Transplantation Medicine
- Pharmacology
Background:
- Solid organ transplant (SOT) recipients have increased susceptibility to invasive fungal infections (IFIs), particularly filamentous fungi.
- Invasive aspergillosis (IA) and mucormycosis post-transplant are associated with high mortality and graft loss.
- Management of these IFIs in SOT recipients presents unique clinical challenges.
Purpose of the Study:
- To critically review current treatment recommendations for IA and mucormycosis in SOT recipients.
- To discuss specific challenges including drug-drug interactions and treatment toxicity.
- To explore future directions in the pharmacological management of post-transplant IFIs.
Main Methods:
- Review of current treatment guidelines and supporting evidence for IA and mucormycosis in SOT recipients.
- Discussion of drug-drug interactions between antifungals (e.g., triazoles) and immunosuppressants.
- Consideration of immunomodulatory therapies and calcineurin inhibitor effects.
Main Results:
- Advances like isavuconazole offer improved tolerability and fewer drug-drug interactions compared to voriconazole.
- Significant room for improvement exists in areas such as combination therapy and immunosuppression reduction strategies.
- The precise role of newer antifungal agents requires further definition.
Conclusions:
- Despite progress, managing mold IFIs in SOT recipients remains challenging.
- Optimizing treatment strategies, including combination therapy and immunosuppression management, is crucial.
- Future research should focus on novel antifungal agents and their specific contributions.
Related Concept Videos
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:24Cystic Fibrosis: Management
Sinus disease and chronic...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: