Invasive mycoses in organ transplant recipients: controversies in prophylaxis and management

Given the high mortality associated with invasive mycoses in transplant recipients, effective prophylaxis for such infections is a worthy goal: an optimal approach has not, however, been devised. Uncertainty and controversy abound regarding the choice of antifungal agent, mode of drug delivery and types of patients who should receive antifungal prophylaxis. The lipid formulations of amphotericin B represent a significant advance in drug delivery of amphotericin B. 7 Although the potential for reduced nephrotoxicity with lipid preparations of amphotericin B has been amply demonstrated, a frequent dilemma pertaining to the use of such agents is whether their high acquisition cost is justifiable in the transplant setting and whether there are data supportive of their superior efficacy as compared with amphotericin B deoxycholate. Finally, a growing body of evidence suggests a potential role for immunomodulatory agents in the treatment of invasive fungal infections. 2,8‐10 This review focuses on: (i) optimizing the approach to antifungal prophylaxis in organ transplant recipients; (ii) treatment of invasive mycoses; (iii) the role of adjunctive therapies, e.g. immunomodulation; and (iv) surgery in the management of invasive mycoses in organ transplant recipients.