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Clin Transplant. 2019 Mar 21:e13544. doi: 10.1111/ctr.13544. [Epub ahead of print]

Invasive Aspergillosis in Solid Organ Transplant Recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.

Author information

1
University Health Network, Division of Infectious Diseases, Multi-Organ Transplant Unit, University of Toronto, Toronto, ON.
2
Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.

Abstract

These updated AST-IDCOP guidelines provide information on epidemiology, diagnosis, and management of Aspergillus after organ transplantation. Aspergillus is the most common invasive mold infection in solid organ transplant (SOT) recipients, and the most common invasive fungal infection among lung transplant recipients. Time from transplant to diagnosis of invasive aspergillosis (IA) is variable but most cases present within the first year post-transplant, with shortest time to onset among liver and heart transplant recipients. The overall 12-week mortality of IA in SOT exceeds 20%; prognosis is worse among those with central nervous system involvement or disseminated disease. Bronchoalveolar lavage galactomannan is preferred for the diagnosis of IA in lung and non-lung transplant recipients, in combination with other diagnostic modalities (e.g. chest CT-scan, culture). Voriconazole remains the drug of choice to treat IA, with isavuconazole and lipid formulations of amphotericin B regarded as alternative agents. The role of combination antifungals for primary therapy of IA remains controversial. Either universal prophylaxis or preemptive therapy are recommended in lung transplant recipients whereas targeted prophylaxis is favored in liver and heart transplant recipients. In these guidelines we also discuss newer antifungals and diagnostic tests; antifungal susceptibility testing and special patient populations. This article is protected by copyright. All rights reserved.

PMID:
30900296
DOI:
10.1111/ctr.13544

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