# The looming threat of invasive fungal infections in heart transplant recipients: Will it be the last of us

## TL;DR

Heart transplant and MCS patients face growing risks from invasive fungal infections due to resistant strains and climate change, but new diagnostics and treatments offer hope.

## Contribution

Highlights the emerging threats of resistant fungi and climate-impacted molds to heart transplant and MCS patients, emphasizing the need for innovative diagnostics and therapies.

## Key findings

- Resistant Candida species like Candida auris and climate-affected molds pose increasing threats to heart transplant and MCS patients.
- Current antifungal treatments are suboptimal and toxic, but new diagnostic and therapeutic strategies offer potential improvements.
- Fungal diagnostics remain limited, complicating early detection and management of invasive fungal infections.

## Abstract

Patients with mechanical circulatory support (MCS) devices and those who undergo heart transplants are at risk for invasive fungal infections (IFI). Though Candida and Aspergillus spp. account for most infections, the evolving epidemiology of resistant-Candida spp. such as Candida auris, endemic mycoses, and other molds impacted by climate change, threaten MCS and transplant patients. Fungal diagnostics are overall limited, and current, widely used antifungal agents are suboptimal with significant toxicities. However, innovative diagnostic strategies coupled with novel antifungal agents for prevention and treatment of invasive fungal disease encourage optimism for MCS and transplant patients and clinicians.