Solid organ transplant patients

Ref ID: 19347

Author:

J. M. Aguado and M. Iversen

Author address:

University Hospital 12 de Octubre, Madrid, Spain and
Rigshospitalet, Copenhagen, Denmark

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Patients who receive a SOT have a substantial risk of IFIs. Candida
and Aspergillus infections are the more relevant in this situation. This
problem will be exemplified by two clinical cases. Candida infection is
especially relevant in abdominal organ transplantation (liver or
kidney-pancreas) and Aspergillus infection is more relevant in thoracic
transplantation (lung and heart).
Candida is especially responsible for invasive candidiasis (abdomi-
nal abscess) and candidemia in liver and pancreas transplant recipi-
ents. Management of invasive candidiasis is especially difficult in
these patients due to the interferences of immunosuppressive drugs
(cyclosporine, tacrolimus, sirolimus and everolimus) with azoles, and
equinocandins are the preferred therapy in this situation. Further-
more the increasing percentage of non-albicans species of Candida is
adding complexity to this problem.
The importance of Aspergillus infection is great because its fre-
quency ranges between 1 and 15% of the TOS and causes a mortal-
ity between 65 and 92%. It is important to note that pulmonary
Meet-the-Expert Sessions
ª 2013 The Authors
16 Mycoses © 2013 Blackwell Verlag GmbH, 56 (Suppl. 3), 11-42
aspergillosis is not just a complication of immediate post-transplant
period, but also the later periods.
There are difficulties to achieve the diagnosis of aspergillosis in
SOT. The sensitivity of galactomannan antigen detection in serum in
SOT recipients is around 50%, but the specificity is high (greater
than 80% overall). The detection of 0.80 units or more of galacto-
mannan in bronchoalveolar lavage fluid appears to be sensitive and
specific for the diagnosis of pulmonary aspergillosis, although there
are no studies designed solely to assess the value of this technique in
this population.
The type of antifungal prophylaxis recommended will depend on
the type of transplant, the analysis of individual risk factors for each
patient, and epidemiological characteristics of each hospital. Depend-
ing on these factors for each type of transplant is recommended uni-
versal prophylaxis or selective prophylaxis, limited only to patients at
high risk for respiratory fungal infection
The recommended treatment of the aspergillosis in a patient with
SOT is voriconazole or amphotericin B, but it should be noted that
the toxicity of these antifungals can be greater than in other
patients. It must take into account the potential risk of nephrotoxi-
city of amphotericin B in kidney transplant recipients, or the poten-
tial liver toxicity of azoles (voriconazole and posaconazole), especially
in the liver transplant recipients.
Finally it should be borne in mind that in patients with SOT is crit-
ical the reduction of immunosuppression as an adjunct to antifungal
treatment, but without jeopardizing the viability of the graft.

Abstract Number: m-06

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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