title: Antifungal prophylaxis in lung transplantation.
abstract: Lung transplant (LTx) patients have an increased risk of developing invasive fungal infections (IFIs), particularly invasive aspergillosis. Rapid identification of the causative fungal pathogen, to allow for early administration of appropriate initial antifungal therapy, in LTx patients has been challenging due to the limited sensitivity and specificity of the diagnostic tools. Hence, there is increasing emphasis on antifungal prophylaxis in the LTx setting, given the high mortality rates and substantial cost of treating IFIs. Evidence for the optimal antifungal prophylactic approach in this setting, however, remains scant and inconsistent. This review will briefly discuss the epidemiology, risk factors, timing and clinical manifestations of fungal infections in LTx patients and will focus primarily on the available evidence related to the efficacy, safety and practicality of current prophylactic strategies in LTx recipients as well as challenges and gaps for future research.
authors.affiliation: Collaborative Drug Discovery Research (CDDR) Group, Faculty of Pharmacy, Universiti Teknologi MARA, 42300 Bandar Puncak Alam, Selangor, Malaysia; Centre for Medicine Use and Safety, Monash University (Parkville Campus), Melbourne, VIC, Australia.
authors.forename: Chin Fen
authors.initials: CF
authors.lastname: Neoh
authors.affiliation: Lung Transplant Service, The Alfred Hospital, Monash University, Melbourne, VIC, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Snell
authors.affiliation: Lung Transplant Service, The Alfred Hospital, Monash University, Melbourne, VIC, Australia.
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Levvey
authors.affiliation: Department of Infectious Diseases, The Alfred Hospital, Monash University, Melbourne, VIC, Australia.
authors.forename: C Orla
authors.initials: CO
authors.lastname: Morrissey
authors.affiliation: Centre for Medicine Use and Safety, Monash University (Parkville Campus), Melbourne, VIC, Australia.
authors.forename: Kay
authors.initials: K
authors.lastname: Stewart
authors.affiliation: Centre for Medicine Use and Safety, Monash University (Parkville Campus), Melbourne, VIC, Australia. Electronic address: david.kong@monash.edu.
authors.forename: David C M
authors.initials: DC
authors.lastname: Kong
mesh_terms: D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018890:Chemoprevention / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016867:Immunocompromised Host; D016040:Lung Transplantation / Q000009:adverse effects*; D009181:Mycoses / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D009894:Opportunistic Infections / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents
keywords: Aspergillosis; Fungal infections; Prevention