Fungal infections in liver transplantation: Prophylaxis, surveillance, and treatment

Fungal infections are significant causes of morbidity and mortality after liver transplantation. Most of the fungal infections are caused by Candida albicans and less frequently by nonalbicans Candida species, Aspergillus species, and Cryptococcus neoformans. The pathogenesis, time of onset, and frequency of invasive fungal infections is unique for the different fungi and is influenced by defined host factors and level of immunosuppression. The improvements in surgical techniques, the dynamic practice of pharmacologic immunosuppression, the increasing awareness of predisposing risk factors, and the use of a variety of preventive strategies (including antifungal, antibacterial, and antiviral prophylaxis) have modified the epidemiology of fungal infection in patients undergoing liver transplantation. This article reviews the changing spectrum of postliver transplantation mycoses and discusses the current strategies in its surveillance, prevention, and treatment. Additionally, novel diagnostic methods and antifungal agents that may impact the treatment of fungal infection in recipients undergoing liver transplantation are discussed.