This protocol is for solid organ transplant recipients who develop pulmonary mucormycosis — a population at significant risk due to the immunosuppression required to maintain graft function. Among transplant recipients, specific first-line approaches have been studied, including in kidney transplant recipients.
First-line management in this population involves early complete surgical debridement with liposomal amphotericin B or amphotericin B lipid complex. The goal of that initial approach is stable disease or partial response on imaging at response assessment (e.g. weekly imaging).
When that imaging goal is not met — that is, when first-line therapy fails to achieve at least stable or partial radiological response — this salvage protocol applies.
The salvage strategy involves switching to a different antifungal drug class or escalating the existing amphotericin B-based regimen, with possible combination approaches in select cases. The complete options, sequencing, and any further details are contained in the full protocol.
The aim is resolution of signs and symptoms of infection and complete response on imaging — recognising that scarring and postoperative changes may make radiological assessment challenging over time.