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Principles and Practice of Transplant Infectious Diseases pp 927–940Cite as

Antifungal Consideration for Transplant Recipients

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Abstract

Invasive fungal infections (IFIs) continue to pose a serious challenge in patients undergoing transplantation. An essential need for treatment with immunosuppressive drugs necessary for sustenance of solid organ allograft; preparatory conditioning regimens use to facilitate hematopoietic stem cell engraftment; drugs given to mitigate hosts’ adaptive cellular immune response for prevention and treatment of graft-versus-host disease (GVHD), and visceral allgraft rejection promote the risk for opportunistic fungal disease. Despite the availability of new-generation diagostic assays, and availability of new antifungal drugs, IFIs continue to pose a serious challenge in the care for patients undergoing transplantation. For prevention and treatment of invasive fungal disease, systemic antifungal drugs are given episodically during the high-risk periods or for extended duration to maintain primary, or secondary suppression after successful resolution of an IFI episode. Selection of appropriate antifungal agent relies upon a number of factors that include patients' susceptibility for infection, spectrum of antimicrobial activity, drug toxicity profile, potential for drug-drug interaction, and clinical efficacy of various classes of antifungal compounds. In authors’ opinion, the role of antifungal drugs in eliciting and promoting drug resistance among clinically relevant fungi should also be an important part of the drug selection process. In this chapter, a review of antifungal drugs with a focus on drug resistance is provided.

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Authors and Affiliations

  1. NYU Langone Medical Center, NYU Langone Health, Department of Pharmacy, New York, NY, USA

    Yanina Dubrovskaya

  2. Smilow Cancer Hospital at Yale-New Haven Health, Department of Pharmacy, New Haven, CT, USA

    Man Yee Merl

  3. Public Health Research Institute, Rutgers Biomedical and Health Sciences, Rutgers New Jersey Medical School, Newark, NJ, USA

    David S. Perlin

  4. Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, USA

    Amar Safdar (Clinical Associate Professor of Medicine)

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  1. Yanina Dubrovskaya
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  2. Man Yee Merl
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  3. David S. Perlin
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  4. Amar Safdar
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Correspondence to Amar Safdar .

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  1. Clinical Associate Professor of Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, TX, USA

    Amar Safdar

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Dubrovskaya, Y., Merl, M.Y., Perlin, D.S., Safdar, A. (2019). Antifungal Consideration for Transplant Recipients. In: Safdar, A. (eds) Principles and Practice of Transplant Infectious Diseases. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9034-4_52

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