Published online Dec 21, 2020. doi: 10.3748/wjg.v26.i47.7485
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.
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.