Minireviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2021; 13(11): 1653-1662
Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1653
Fungal infections following liver transplantation
Madiha Khalid, Ritesh Neupane, Humayun Anjum, Salim Surani
Madiha Khalid, Department of Medicine, Orlando Health Medical Center, Orlando, FL 32806, United States
Ritesh Neupane, Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA 17033, United States
Humayun Anjum, Department of Medicine, University of North Texas, Denton, TX 76203, United States
Salim Surani, Department of Pulmonary Critical Care and Sleep Medicine, Texas A&M Health Science Center, Corpus Christi, TX 78405, United States
Author contributions: Khalid M has been involved in the review of literature, writing, and review; Neupane R and Anjum H are involved in writing and review; Anjum S is involved in all aspects of the manuscript.
Conflict-of-interest statement: No conflict-of-interest statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FACP, FCCP, MD, MSc, Doctor, Professor, Department of Pulmonary Critical Care and Sleep Medicine, Texas A&M Health Science Center, 701 Ayers Street, Corpus Christi, TX 78405, United States. srsurani@hotmail.com
Received: March 25, 2021
Peer-review started: March 25, 2021
First decision: June 15, 2021
Revised: June 24, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: November 27, 2021
Abstract

With increasing morbidity and mortality from chronic liver disease and acute liver failure, the need for liver transplantation is on the rise. Most of these patients are extremely vulnerable to infections as they are immune-compromised and have other chronic co-morbid conditions. Despite the recent advances in practice and improvement in diagnostic surveillance and treatment modalities, a major portion of these patients continue to be affected by post-transplant infections. Of these, fungal infections are particularly notorious given their vague and insidious onset and are very challenging to diagnose. This mini-review aims to discuss the incidence of fungal infections following liver transplantation, the different fungi involved, the risk factors, which predispose these patients to such infections, associated diagnostic challenges, and the role of prophylaxis. The population at risk is increasingly old and frail, suffering from various other co-morbid conditions, and needs special attention. To improve care and to decrease the burden of such infections, we need to identify the at-risk population with more robust clinical and diagnostic parameters. A more robust global consensus and stringent guidelines are needed to fight against resistant microbes and maintain the longevity of current antimicrobial therapies.

Keywords: Invasive fungal infections, Liver transplantation, Candidiasis, Antifungal prophylaxis, Aspergillosis, Cryptococcus

Core Tip: Fungal infections post liver transplant remains the predominant source of morbidity and mortality despite the incidence being low. This is because of evasive clinical features coupled with difficulty to isolate and culture these pathogens. Therefore, appropriate patients are selected for prophylactic regimen based on specific risk factors to curb the rise of drug-resistant species. Traditional regimens include fluconazole or liposomal amphotericin with a shift towards echinocandins based on recently published and promising data.