Antifungal Consideration for Transplant Recipients

Invasive fungal infections (IFIs) continue to pose a serious challenge in patients undergoing transplantation. An essential need for treatment with immunosuppressive drugs necessary for sustenance of solid organ allograft; preparatory conditioning regimens use to facilitate hematopoietic stem cell engraftment; drugs given to mitigate hosts’ adaptive cellular immune response for prevention and treatment of graft-versus-host disease (GVHD), and visceral allgraft rejection promote the risk for opportunistic fungal disease. Despite the availability of new-generation diagostic assays, and availability of new antifungal drugs, IFIs continue to pose a serious challenge in the care for patients undergoing transplantation. For prevention and treatment of invasive fungal disease, systemic antifungal drugs are given episodically during the high-risk periods or for extended duration to maintain primary, or secondary suppression after successful resolution of an IFI episode. Selection of appropriate antifungal agent relies upon a number of factors that include patients' susceptibility for infection, spectrum of antimicrobial activity, drug toxicity profile, potential for drug-drug interaction, and clinical efficacy of various classes of antifungal compounds. In authors’ opinion, the role of antifungal drugs in eliciting and promoting drug resistance among clinically relevant fungi should also be an important part of the drug selection process. In this chapter, a review of antifungal drugs with a focus on drug resistance is provided.