Increasingly potent
immunosuppressive agents have dramatically reduced the incidence of rejection of transplanted organs while increasing patients' susceptibility to
opportunistic infections.
Invasive fungal infections (IFIs) following solid
organ transplantation, despite having a lower incidence than bacterial and
viral infections, remain a major cause of morbidity and mortality.
Fungal infections in patients with different types of solid organ transplant have different incidences, underlying pathogenetic mechanisms and modes of clinical presentation. Two genera, Aspergillus and Candida, are responsible for the vast majority of
fungal infections in solid organ transplant recipients accounting for more than 80% of IFIs. Candidaemia is the most frequent clinical manifestation of Candida spp.
infection, regardless of the transplanted organ and typically occurs within 1 month of
transplantation. Management of
fungal infections varies widely among different transplant centres. Large multicentre, randomized controlled trials evaluating risk factors, diagnosis, prophylaxis and treatment strategies for
fungal infection in organ transplant recipients are lacking. Consequently, a uniform consensus on each of these does not exist, and clinical practice has evolved mainly from case series, anecdotal experiences and single-centre trials. Targeted prophylaxis is recommended for high-risk liver, pancreas and small bowel patients. Management of established
infection is based on guidelines in the general population and should take into consideration prior prophylaxis, severity of
infection and the possibility of
drug-drug interactions in these immunosuppressed patients.