Risk Factors and Outcomes of Invasive Candida Infections in Heart Transplant Recipients: A Case-Control Study

Invasive Candida infections (ICI) are the most common invasive fungal infections in solid organ transplant recipients. There are limited contemporary data on the risk factors for infection in heart transplant (HT) recipients especially since the expansion of temporary mechanical circulatory support (MCS) use.

This was a case-control study conducted at a tertiary care academic hospital of HT recipients from January 2022 to January 2024. All patients who developed ICI by the detection of Candida species from a normally sterile site were included as cases. Four controls who underwent HT, two before the case and two after the case, were selected. ​Fisher's exact or Mann-U-Whitney tests were used for the analysis.

There were 12 cases and 48 controls out of a total of 117 transplants during the study period​. The proportion of ICI was 10.6%. The median time to ICI from transplant was 16 days (IQR 10, 83). The most common organisms isolated were Candida parapsilosis and Candida albicans. The majority of infections were mediastinitis. Risk factors for ICI included receipt of antibiotics for more than 7 days within 1 month prior to transplant (58.3% vs. 22.9%, p = 0.03), tracheostomy (41.7% vs. 10.4%, p = 0.02), prolonged chest tube placement (13 vs. 9 days, p = 0.02), and temporary MCS (p = 0.042). Patients who developed ICI had increased 90-day all-cause mortality compared to controls (33.3% vs. 4.2%, p = 0.01).

This study identified several risk factors for ICI following HT. Further research is essential to develop interventions that mitigate these risk factors in this patient population.