Donor-Derived Fungal Infections in Organ Transplant Recipients: Guidelines of the American Society of Transplantation, Infectious Diseases Community of Practice

Singh, Nina; Huprikar, Shirish; Burdette, Steven D.; Morris, Michele; Blair, Janis E.; Wheat, L. Joseph

doi:10.1111/j.1600-6143.2012.04100.x

Cited by 152 publications

(166 citation statements)

References 114 publications

(150 reference statements)

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“…The transmission rate of coccidioidomycosis from donors with active infection to recipients has been reported to be 43% (median of 30 days post-transplant), with a mortality rate of 28.5% [36]. Therefore, screening of living donors from the endemic areas is recommended [37]. Donors with active infection should be excluded, and donation should be delayed until resolution of infection [37].…”

Section: How To Minimize the Risk Of Coccidioidomycosis In Solid Orgamentioning

confidence: 99%

Antifungal Prophylaxis in Lung Transplant Recipients

Patel

Eschenauer²,

Stuckey³

et al. 2016

Transplantation

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Invasive fungal infection remains a serious postoperative complication in lung transplant recipients and is associated with significant morbidity and mortality. Although most lung transplant centers use antifungal prophylaxis, consensus on the strategy, choice of antifungal agent(s), route of administration, and duration of prophylaxis have not been established. This review provides an overview of the epidemiology and risk factors for common fungal infections seen in lung transplant recipients, evaluates the clinical efficacy and toxicity of the various antifungal agents used to prevent infection, and offers recommendations and opportunities for future research. Currently available data evaluating the efficacy of antifungal prophylaxis strategies is limited by a lack of prospective, randomized clinical trial data and variability in patient populations, prophylactic and immunosuppressive strategies, dosing, durations of use of antifungal agents, and definitions of invasive infection. There is controversy regarding significant risk factors for invasive fungal infection, which has limited the development and validation of targeted prophylactic strategies. Inhaled formulations of amphotericin B remain the most widely studied option for universal prophylaxis and have been shown to be effective in reducing the incidence of invasive Aspergillosis as compared with no prophylaxis. Concern over early postoperative extrapulmonary infection may suggest a benefit of initial prophylaxis with a systemic azole. Long-term use of systemic antifungals is not optimal due to emerging evidence of long-term toxicities. Multicenter, randomized trials are needed to ascertain the optimal prophylactic strategy in lung transplant recipients. New agents and delivery mechanisms may offer additional opportunities for comparative research.

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“…Several studies have addressed this issue over the last years [3,5e7]: factors such as prolonged immunosuppression, pulses of corticosteroids, chronic graft dysfunction, previous use of broad-spectrum antibiotics, neutropenia, cytomegalovirus infection, diabetes, and advanced age have been associated to IFI. Transmission may be donorderived [8,9], sometimes associated with transplant tourism [10] or with contamination of preservation fluid [11]. IFI may result from reactivation of latent infection in the recipient (e.g.…”

mentioning

confidence: 99%