Abstract
Fungal infections remain a significant cause of morbidity and mortality in renal transplant recipients. Fungal colonization is associated with use of broad spectrum antibacterial agents, pre-transplant and post-transplant immunosuppressive therapy. In the post-transplant period, differentiating between fungal colonization and infection is often difficult and remains imprecise. The period of 1 to 6 months after kidney transplant is marked by opportunistic fungal infection. During induction or periods of enhanced immunosuppression oral nonabsorbable or topical antifungal agents such as clotrimazole or nystatin are typically administered to prevent mucocutaneous Candida infection. The lipid formulations of amphotericin B (LFAB) are associated with lower risks for nephrotoxicity. Voriconazole appears to be superior to conventional AmB for the treatment of invasive aspergillosis. The echinocandins, including caspofungin are fungicidal for Candida species. The development of any serious fungal infection in a transplant recipient mandates a critical evaluation of the immunosuppressive regimen.
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