title: Invasive fungal infections in liver transplantation.
abstract: Invasive fungal infections (IFIs) in immunocompromised patients, particularly liver transplant recipients, are the subject of increasing clinical attention. Although the overall incidence of fungal infections in liver transplant recipients has declined due to the early treatment of high-risk patients, the overall mortality rate remains high, particularly for invasive candidiasis and aspergillosis. IFIs after liver transplantation are strongly associated with negative outcomes, increasing the cost to recipients. Numerous studies have attempted to determine the independent risk factors related to IFIs and to reduce the morbidity and mortality with empirical antifungal prophylaxis after liver transplantation. Unfortunately, fungal infections are often diagnosed too late; symptoms can be mild and non-specific even with dissemination. Currently, no consensus exists on which patients should receive antifungal prophylaxis, when prophylaxis should be given, which antifungal agents should be used, and what duration is effective. This review highlights the types of IFI, risk factors, diagnosis, antifungal prophylaxis, and treatment after liver transplantation. With the early identification of patients at high risk for IFIs and the development of new molecular diagnostic techniques for early detection, the role of antifungal compounds in fungal infection prophylaxis needs to be established to improve the survival rate and quality of life in liver transplant patients.
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Liu
authors.forename: Zongxin
authors.initials: Z
authors.lastname: Ling
authors.forename: Lanjuan
authors.initials: L
authors.lastname: Li
authors.forename: Bing
authors.initials: B
authors.lastname: Ruan
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D042241:Early Diagnosis; D005658:Fungi / Q000472:pathogenicity*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D025202:Molecular Diagnostic Techniques; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents