Treatment of Pulmonary Mucormycosis in Solid Organ Transplantation
Pulmonary mucormycosis presents a critical management challenge in solid organ transplant recipients, where immunosuppression substantially heightens susceptibility. Prompt recognition and an aggressive, coordinated approach are essential.
This protocol addresses pulmonary mucormycosis occurring in patients with a history of solid organ transplantation — a population at elevated risk in whom timely intervention is paramount. Evidence from kidney transplant recipients specifically informs aspects of the dosing strategy within this guideline.
The approach combines early surgical intervention with systemic antifungal therapy initiated without delay. When disease stabilises, a transition to oral antifungal agents is supported. The complete sequence, agent selection criteria, and escalation pathway are detailed in the full protocol.
The primary objective is achieving stable disease or a partial response, as assessed by serial imaging (e.g. weekly). Intravenous treatment is continued until this endpoint is reached.
References
The guideline group strongly supports an early complete surgical treatment for mucormycosis whenever possible, in addition to systemic antifungal treatment.
In kidney transplant recipients, amphotericin B lipid complex 10 mg/kg per day has been given.
Doses should not be slowly increased over several days; rather, the full daily dose should be given from the first treatment day.
When switching to oral treatment, use of isavuconazole or posaconazole delayed release tablets is strongly supported.
There is moderate support for intravenous treatment until stable disease is achieved.
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