BackgroundLung transplantation is an important treatment option for various end-stage lung diseases. However, survival remains limited due to graft rejection and infections. Despite that fungal infections are frequent and carry a bad prognosis, there is currently no consensus on efficacy, optimal drug, route or duration of antifungal prophylaxis. This narrative review summarizes current strategies for antifungal prophylaxis after lung transplantation. MethodsEnglish-language articles in Embase, Pubmed, UptoDate and bibliographies were used to assess efficacy and safety of available antifungal agents for prophylaxis in adult lung transplant recipients. ResultsOverall, there are limited high quality data. Universal prophylaxis is more widely used and may be preferable over targeted prophylaxis. Both formulations of inhaled amphotericin B and systemic azoles are effective at reducing fungal infection rates, yet with their own specific advantages and disadvantages. The benefit of combination regimens has yet to be proven.Considering the post-transplant timing of onset of fungal infections, postoperative prophylaxis during the first postoperative months seems indicated for most patients. ConclusionsBased on existing literature, universal antifungal prophylaxis with inhaled amphotericin B and/or systemic voriconazole for at least 3 to 6 months after lung transplantation may be advisable, with a slight preference for amphotericin B because of its better safety profile.