| Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc |
| Journal website http://www.jocmr.org |
Review
Volume 7, Number 6, June 2015, pages 371-378
Fungal Infections in Renal Transplant Patients
Tables
| Type of infection | Drug | Dosage | Duration of treatment |
|---|---|---|---|
| Candiduria | Fluconazole | 200 - 400 mg/day | Several days before and after the procedure |
| Candidemia | Fluconazole | Loading dose: 800 mg/day, then 400 mg/day | 14 days after first negative blood culture result |
| Invasive aspergillosis | Voriconazole | 4 mg/kg twice daily | Until all signs and symptoms of infection have resolved for at least 2 weeks |
| Cryptococcosis | Fluconazole | 400 mg/day | 6 - 12 months |
| Mucormycosis | Liposomal amphoteracin B | 5 mg/kg/day | Until patient exhibits a favorable response |
| Transplant organ | Targeted pathogen | High-risk characteristics | Agent | Duration |
|---|---|---|---|---|
| Liver | Aspergillus | Poor allograft function; fulminant hepatic failure pretransplantation; reexploration or retransplantation; hemodialysis; isolation of aspergillus from any site | Lipid AmB | 1 - 4 weeks |
| Liver | Candida | Repeated operation; higher intraoperative transfusion requirements; longer operation time; renal failure; ICU stay | Fluconazole alternative: echinocandin or lipid AmB | 1 - 4 weeks |
| Lung | Aspergillus | Airway specimen cultures positive for aspergillus, particularly for patients with rejection or poor graft function; increased immunosuppression | Itraconazole or voriconazole or lipid-AmB A (full dose I/V) ± nebulized AmB | Depends on CT findings and clearance of sputum cultures, appearance of tracheal anastomosis. 1 to 6 months |
| Pancreas | Candida | All procedures (risk increased with enteric drainage, anastomotic leak, pancreas transplantation after kidney transplantation, pancreatitis) | Fluconazole alternative: echinocandin or lipid AmB | 4 weeks |
| Bowel | Candida | All procedures (risk increased with peritonitis or leaks, reexploration, renal failure, ischemia, CMV infection, parenteral nutrition) | Fluconazole alternative: echinocandin or lipid AmB | 2 - 4 weeks |