title: Fungal infections after lung transplantation.
abstract: OBJECTIVE
  Lung transplant's Achilles heel is chronic rejection. This is the reason why high immunosuppression is used, which leads to the development of infections. Fungal infections are a great obstacle in lung transplant patients' progress, not only because of their impact on patient survival, but also because fungal infections indirectly have an influence on the graft's progress. This review highlights the changing spectrum of invasive fungal infections as well as the most recent developments in diagnosis, prophylaxis, treatment and monitoring of lung transplantation.
  
  
  RESULTS
  Fungal infections have a bimodal presentation: early onset, in relation to difficult postsurgeries and prior colonizations, and late onset, primarily in relation to chronic rejection and terminal renal insufficiency. The clinical impact of non-Aspergillus moulds is still unknown. Recent efforts have focused on nonculture-based methods to establish a rapid diagnosis. However, multicentre studies are needed to establish the diagnostic value of galactomannan antigen assay in invasive aspergillosis in lung transplantation. In addition, studies of the sensitivity and specificity of PCR assays are required to establish their diagnostic value. Unfortunately, only some advances in the diagnosis of aspergillosis have been achieved.
  
  
  CONCLUSIONS
  Prophylaxis should be tailored according to the different individual patient's risk status. Combined treatments, including surgical therapy, may be useful in some patients.
authors.affiliation: Lung Transplant Unit, Hospital Universitario La Fe, Valencia, Spain. sole_amp@gva.es
authors.forename: Amparo
authors.initials: A
authors.lastname: Solé
authors.forename: Miguel
authors.initials: M
authors.lastname: Salavert
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000472:pathogenicity; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008168:Lung / Q000382:microbiology; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000517:prevention & control* / Q000628:therapy; D016040:Lung Transplantation / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents