Invasive aspergillosis in lung and heart transplant recipients

Invasive aspergillosis (IA) is a significant cause of morbidity and mortality in lung transplant (LT) and heart transplant (HT) recipients. Most of the risk is in the first year post-transplant. In this review, the epidemiology, diagnosis and treatment of IA are examined in detail. The challenges in diagnosis are highlighted. Whilst culture and histology are the cornerstone, the emerging role of serological and molecular methods is discussed. Treatment is a multipronged approach with drug-drug interactions and toxicity impacting outcomes. New antifungals are in development and have the potential to improve efficacy and reduce toxicity. Ongoing research is required to fully delineate the risk factors for IA, determine the optimal prevention strategy and develop new diagnostic tools and treatments so that outcomes from IA in LT and HT recipients continue to improve.