Invasive Pulmonary Aspergillosis in Solid Organ Transplant Recipients

Abstract

Invasive aspergillosis (IA) continues to be a significant cause of morbidity and mortality in solid organ transplant recipients. The highest incidence of IA is noted in lung transplant recipients, while the lowest incidence is in kidney transplant recipients. Common risk factors for the development of invasive aspergillosis include environmental exposures and net state of immunosuppression. Unique risk factors to lung transplants include airway colonization, and receipt of single lung transplant. Liver transplant recipients receiving renal replacement therapy on the other hand have the highest risk of IA. Liver transplant recipients also have the highest incidence of disseminated disease while tracheobronchitis is the most common manifestation of IA in lung transplant recipients. Prophylaxis with antifungal agents is recommended in lung and liver transplant recipients. The drug of choice for the treatment of IA remains to be voriconazole. The role of combination therapy for the treatment of IA in solid organ transplant recipients remains undetermined.