Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2020; 26(47): 7485-7496
Published online Dec 21, 2020. doi: 10.3748/wjg.v26.i47.7485
Invasive fungal infection before and after liver transplantation
Alberto Ferrarese, Annamaria Cattelan, Umberto Cillo, Enrico Gringeri, Francesco Paolo Russo, Giacomo Germani, Martina Gambato, Patrizia Burra, Marco Senzolo
Alberto Ferrarese, Francesco Paolo Russo, Giacomo Germani, Martina Gambato, Patrizia Burra, Marco Senzolo, Multivisceral Transplant Unit, Padua University Hospital, Padua 35128, Italy
Annamaria Cattelan, Tropical and Infectious Disease Unit, Padua University Hospital, Padua 35128, Italy
Umberto Cillo, Enrico Gringeri, Padua University Hospital, Hepatobiliary Surgery and Liver Transplant Center, Padua 35128, Italy
Author contributions: Ferrarese A, Cattelan A and Senzolo M participated in research design, data analysis, and writing of the manuscript; Cillo U, Gringeri E, Russo FP, Germani G, Gambato M and Burra P participated in research design and preparation of the manuscript; all authors have contributed to, read, and approved the manuscript.
Conflict-of-interest statement: The Authors have nothing to disclose regarding this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Alberto Ferrarese, MD, Multivisceral Transplant Unit, Padua University Hospital, via Giustiniani 2, Padua 35128, Italy.
Received: October 18, 2020
Peer-review started: October 18, 2020
First decision: November 13, 2020
Revised: November 15, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: December 21, 2020

Invasive infections are a major complication before liver transplantation (LT) and in the early phase after surgery. There has been an increasing prevalence of invasive fungal disease (IFD), especially among the sickest patients with decompensated cirrhosis and acute-on-chronic liver failure, who suffer from a profound state of immune dysfunction and receive intensive care management. In such patients, who are listed for LT, development of an IFD often worsens hepatic and extra-hepatic organ dysfunction, requiring a careful evaluation before surgery. In the post-transplant setting, the burden of IFD has been reduced after the clinical advent of antifungal prophylaxis, even if several major issues still remain, such as duration, target population and drug type(s). Nevertheless, the development of IFD in the early phase after surgery significantly impairs graft and patient survival. This review outlines presentation, prophylactic and therapeutic strategies, and outcomes of IFD in LT candidates and recipients, providing specific considerations for clinical practice.

Keywords: Acute-on-chronic liver failure, Sepsis, Cirrhosis, Candidemia, Acute liver failure, Invasive fungal infection

Core Tip: Invasive fungal infection significantly influences the outcome of patients with acute liver failure or cirrhosis awaiting liver transplantation, as well as their post-operative course. This state-of-the-art review comprehensively describes the epidemiology and the therapeutic options on this field.