The 2015 International Society for Heart and Lung Transplantation Guidelines for the management of fungal infections in mechanical circulatory support and cardiothoracic organ transplant recipients: Executive summary.
- Publication Type:
- Journal Article
- The Journal of Heart and Lung Transplantation, 2016, 35 (3), pp. 261 - 282
- Issue Date:
The field of cardiothoracic transplantation (CT) has evolved significantly, but infections remain an important cause of morbidity and mortality, particularly fungal infections (FIs). The higher mortality associated with FIs has prompted the institution of center-specific anti-fungal prophylactic strategies.1, 2, 3, 4, 5 In the absence of existing clinical trials, the International Society for Heart and Lung Transplantation (ISHLT) Infectious Diseases Council has committed to convening an international and multidisciplinary panel of experts in the field to address the issue. The panel members are recognized leaders in the field of heart and lung transplantation and mechanical circulatory support devices (MCSDs), and were selected from established transplant centers worldwide by the chairs. The panel members approved the most relevant questions to be addressed in the areas of epidemiology, diagnosis, prophylaxis, and treatment of FIs, including therapeutic drug monitoring (TDM) of anti-fungal agents in adult and pediatric heart, lung, and MCSD patients. The panel was subsequently divided into working groups, each headed by their respective chairs, for epidemiology, diagnosis, prophylaxis, treatment, TDM, and pediatrics. A comprehensive literature search was performed by the panel chairs and was disseminated to the working groups. The working groups reviewed the existing literature to answer the identified questions based on the published evidence or, in the absence of published evidence, to provide guidance based on prevailing expert knowledge and experience. Each group reviewed, evaluated, and summarized the relevant evidence and then presented its findings at a workshop held at the annual ISHLT meeting in Montreal on April 23, 2013. The recommendations were graded according to ISHLT Standards and Guidelines Committee documents. Disagreements were resolved by iterative discussion and consensus. Subsequently, each group chair prepared an article with input from the members of the group and submitted it to the cochairs. The articles were modified based on the feedback of the cochairs. The executive summaries for each topic were generated from the articles by the cochairs and were submitted to the ISHLT Standards and Guidelines Committee. Each panel member disclosed his or her potential conflicts of interest. The panel recommendations do not include management of Pneumocystis jiroveci, Cryptococcus, and endemic mycoses in CT recipients (Table 1 and Table 2).
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