Hospital of the University of Cologne, Department I of Internal Medicine, Clinical Trials Unit II for Infectious Diseases (BMBF 01KI0771), Kerpener Strasse 62, 50937 Köln, Germany.
Expert Opin Pharmacother. 2010 Jan;11(1):95-113. doi: 10.1517/14656560903405639.
Invasive fungal diseases (IFD) are severe complications in patients receiving immunosuppression after solid organ or allogeneic stem cell transplantation. Extensive study has been conducted on therapeutic strategies for IFD in neutropenic patients, mostly those with hematological malignancy. There is an ongoing discussion on whether these studies may be applied to transplant patients as well.
We have reviewed relevant literature on transplantation and clinical mycology of the last 20 years and selected articles relevant for today's treatment decisions. This article reports on the epidemiology of IFD in transplant recipients and current antifungal drugs in the context of tansplantation medicine. For invasive aspergillosis and invasive candidiasis, we give a detailed report of current clinical evidence.
This review is intended as a quick-start for clinicians and other care providers new to transplant care and as an update for experienced transplant physicians. In a field in which evidence is scarce and conflicting, we provide evidence-based strategies for diagnosing and treating the most relevant IFD in transplant recipients.
Physicians treating transplant patients should maintain a high level of awareness towards IFD. They should know the local epidemiology of IFD to make the optimal decision between current diagnostic and therapeutic strategies. Prophylaxis or early treatment should be considered given the high mortality of IFD.
侵袭性真菌病（IFD）是实体器官或异基因干细胞移植后接受免疫抑制治疗的患者的严重并发症。在中性粒细胞减少症患者中，尤其是那些患有血液恶性肿瘤的患者中，已经对 IFD 的治疗策略进行了广泛的研究。目前正在讨论这些研究是否也可以应用于移植患者。
我们回顾了过去 20 年中与移植和临床真菌学相关的文献，并选择了与今天的治疗决策相关的文章。本文报告了移植受者中 IFD 的流行病学以及移植医学背景下的当前抗真菌药物。对于侵袭性曲霉病和侵袭性念珠菌病，我们详细报告了当前的临床证据。
对于刚开始接触移植护理的临床医生和其他护理提供者，本综述旨在作为快速入门指南，对于经验丰富的移植医生，本综述也可作为更新内容。在证据稀缺和相互矛盾的领域，我们为诊断和治疗移植受者中最相关的 IFD 提供了基于证据的策略。
治疗移植患者的医生应保持对 IFD 的高度警惕。他们应该了解 IFD 的本地流行病学，以便在当前的诊断和治疗策略之间做出最佳决策。鉴于 IFD 的高死亡率，应考虑进行预防或早期治疗。
