Invasive Candida infections in solid organ transplant recipients between 2008 and 2020

Contemporary data on the epidemiology and outcomes of invasive candidiasis (IC) in solid organ transplant recipients (SOTr) are limited. This retrospective multicenter cohort study, nested within the Swiss Transplant Cohort Study, describes the epidemiology and outcomes of IC in SOTr from 2008 to 2020. Among 4755 patients identified, 205 (4.3%) had 262 episodes of IC. One-year cumulative incidence of IC was 2.8% (95% confidence interval [CI], 2.4, 3.3) and decreased during the study period (P = .046). Candidemia was less frequently encountered (0.67%, 95% CI, 0.47, 0.94) than intra-abdominal (1.4%, 95% CI, 1.1, 1.7) and other infection sites (0.93%, 95% CI, 0.68, 1.2). Most infections occurred in the first year posttransplant (65.3%, 171/262), with Candida albicans being the most common species (69.6%, 181/262), followed by C. glabrata (27.4%, 32/117). All-cause 12-week mortality was 23.5%, highest in liver (34.5%) and heart (30%) transplant recipients. Candidemia was associated with a high 12-week mortality (51.1%), significantly impacting 1-year posttransplant mortality, especially if it occurred in the first 3 months (hazard ratio, 26; 95% CI, 14.2, 47.4). In conclusion, we report high rates of IC, predominantly intra-abdominal, with decreasing incidence during the study period. Mortality remains high, especially for liver and heart transplant recipients and in patients with candidemia. Those observations can inform future prophylactic and other strategies in the care of SOTr.