Salmanton-García Jon, Giacinta Alessandro, Giannella Maddalena, Vena Antonio, Muñoz Patricia, Cornely Oliver A, Valerio Maricela
Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, Herderstraße 52, 50931, Cologne, Germany.
University Hospital Cologne, Cologne, Germany.
Infection. 2025 Jul 4. doi: 10.1007/s15010-025-02575-z.
Invasive fungal diseases (IFD) present serious risks to solid organ transplant recipients, particularly in the first 180 days post-transplant. Existing European and US guidelines offer limited evidence, prompting a shift away from universal prophylaxis due to adverse effects, drug-interactions, and costs. This study investigates antifungal prophylaxis practices in transplant centers to guide IFD management.
From May 2023 to May 2024, tertiary care institutions completed an online survey on antifungal prophylaxis post-transplant. Data included transplant volumes, IFD incidence by pathogen, and prophylactic strategies.
Responses from 64 centers in 32 countries, mainly in Europe, highlighted kidney and liver as the most common transplants. Prophylaxis was universal in lung transplants and common in liver, bowel, and heart transplants, often triggered by reintervention or Candida spp. colonization. Preferred agents included liposomal amphotericin B and fluconazole.
This global survey reveals substantial variation in antifungal prophylaxis practices among solid organ transplant centers, driven by a lack of standardized, evidence-based guidelines. Our findings underscore the urgent need for harmonized recommendations that reflect evolving fungal epidemiology, improved diagnostics, and new antifungal agents.
侵袭性真菌病（IFD）对实体器官移植受者构成严重风险，尤其是在移植后的前180天。现有的欧洲和美国指南提供的证据有限，由于不良反应、药物相互作用和成本等因素，促使人们不再采用普遍预防措施。本研究调查了移植中心的抗真菌预防措施，以指导IFD的管理。
2023年5月至2024年5月，三级医疗机构完成了一项关于移植后抗真菌预防的在线调查。数据包括移植量、按病原体分类的IFD发病率以及预防策略。
来自32个国家（主要是欧洲）的64个中心的回复显示，肾脏和肝脏移植是最常见的移植类型。肺移植普遍采用预防措施，肝脏、肠道和心脏移植也较为常见，通常是由再次干预或念珠菌属定植引发的。首选药物包括脂质体两性霉素B和氟康唑。
这项全球调查显示，由于缺乏标准化的循证指南，实体器官移植中心的抗真菌预防措施存在很大差异。我们的研究结果强调迫切需要统一的建议，以反映不断变化的真菌流行病学、改进的诊断方法和新的抗真菌药物。
