State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Department of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
Int J Infect Dis. 2011 May;15(5):e298-304. doi: 10.1016/j.ijid.2011.01.005. Epub 2011 Feb 22.
Invasive fungal infections (IFIs) in immunocompromised patients, particularly liver transplant recipients, are the subject of increasing clinical attention. Although the overall incidence of fungal infections in liver transplant recipients has declined due to the early treatment of high-risk patients, the overall mortality rate remains high, particularly for invasive candidiasis and aspergillosis. IFIs after liver transplantation are strongly associated with negative outcomes, increasing the cost to recipients. Numerous studies have attempted to determine the independent risk factors related to IFIs and to reduce the morbidity and mortality with empirical antifungal prophylaxis after liver transplantation. Unfortunately, fungal infections are often diagnosed too late; symptoms can be mild and non-specific even with dissemination. Currently, no consensus exists on which patients should receive antifungal prophylaxis, when prophylaxis should be given, which antifungal agents should be used, and what duration is effective. This review highlights the types of IFI, risk factors, diagnosis, antifungal prophylaxis, and treatment after liver transplantation. With the early identification of patients at high risk for IFIs and the development of new molecular diagnostic techniques for early detection, the role of antifungal compounds in fungal infection prophylaxis needs to be established to improve the survival rate and quality of life in liver transplant patients.
免疫功能低下患者（尤其是肝移植受者）的侵袭性真菌感染（IFI）越来越受到临床关注。尽管由于对高危患者的早期治疗，肝移植受者真菌感染的总体发生率有所下降，但总体死亡率仍然很高，尤其是侵袭性念珠菌病和曲霉菌病。肝移植后的 IFI 与不良结局密切相关，增加了受者的成本。许多研究试图确定与 IFI 相关的独立危险因素，并通过肝移植后经验性抗真菌预防来降低发病率和死亡率。不幸的是，真菌感染通常诊断得太晚；即使有扩散，症状也可能轻微且非特异性。目前，对于哪些患者应接受抗真菌预防、何时给予预防、应使用哪些抗真菌药物以及多长时间有效等问题，尚无共识。本综述重点介绍了肝移植后的 IFI 类型、危险因素、诊断、抗真菌预防和治疗。通过早期识别 IFI 高危患者和开发新的分子诊断技术进行早期检测，可以确定抗真菌化合物在预防真菌感染中的作用，以提高肝移植患者的生存率和生活质量。
