Changing patterns of fungal infection in transplantation

Multiple risk factors place the organ transplant recipient at an increased risk for fungal infection. Some of the risk factors for fungal infection are similar to those observed in comparable nontransplant abdominal, cardiothoracic, and genitourinary surgery in immunocompetent patients. However, the changing patterns of newer immunosuppressive agents, complex surgical techniques and artificial devices, and donor considerations all have contributed to the intrinsic risk for fungal infection in organ recipients. Fungal pathogens, some previously unknown or considered saprophytes, have gradually changed the complexion of fungal disease in solid organ recipients. Consequently, a heightened clinical suspicion for both traditional and emerging fungal pathogens is warranted. The early recognition of these fungal pathogens and the wide array of associated clinical presentations, in conjunction with the identification of at-risk organ recipients, are essential requirements in reducing morbidity and mortality.