Papel de la anidulafungina en el paciente con trasplante de órgano sólido

Abstract

The incidence of invasive fungal infections in solid organ transplant recipients varies according to the type of transplant. Most of these infections are due to Candida spp. and less frequently to Aspergillus spp. or other fungi such as Cryptococcus spp. Currently, overall mortality due to invasive fungal infections in solid organ transplant recipients ranges between 25% and 80% and half of these deaths are directly related to the fungal infection. A number of well-defined risk factors favor the development of invasive fungal infections in these patients and allow antifungal prophylaxis in high-risk patients. The candins are a new class of antifungal agent with potential use both in the treatment and in the prophylaxis of invasive fungal infections in solid organ transplant recipients. Anidulafungin has a wider spectrum of action and lower toxicity than caspofungin. Anidulafungin has good in vitro antifungal activity against Candida and Aspergillus spp. One of the most interesting features of anidulafungin in solid organ transplant recipients is that this drug is not metabolized by or eliminated through the kidney so that dosage adjustments are not required in these patients, who frequently show renal function alterations. Moreover, anidulafungin is not metabolized in the liver and is consequently free of interactions with other drugs metabolized in this organ. Equally, dosage adjustments are not required in patients with severe liver disease or in those administered immunosuppressive agents such as prednisone, cyclosporin A, tacrolimus, mofetil mycophenolate or sirolimus. Although experience is still limited, these data suggest that anidulafungin will be highly useful in the clinical management of solid organ transplant recipients.