Risk factor analysis for early and late invasive Candida infections in solid organ transplant recipients

Contemporary data on risk factors for invasive candidiasis (IC) in solid organ transplant recipients (SOTr) are rare. This follow-up study on a large multicenter cohort study, nested within the Swiss Transplant Cohort Study, identifies risk factors for IC during the first year posttransplant. Among 4755 and 4519 SOTr identified between 0-3 months (early) and 4-12 months (late) posttransplant, 90 (1.9%) and 48 (1.1%) had 109 and 50 episodes of IC, respectively. Posttransplant Candida colonization (HR:3.2; 95%CI:1.67,6.14; p<0.001), and posttransplant anastomosis (HR:3.14; 95%CI:1.74,5.69; p<0.001) and bleeding/vascular complications (HR:3.66; 95%CI:2.38,5.62; p<0.001) were independent risk factors for early IC, while transplantation between 2015-2020 (HR:0.57; 95%CI:0.38,0.88, p=0.011) and male sex (HR:0.63; 95%CI:0.59,0.88; p=0.026) demonstrated lower risk for early IC in multivariable analysis for all transplant types. Systemic antifungal prophylaxis (HR:30.9; 95%CI:4.9,194; padj=0.003) was associated with increased risk of early IC in kidney/kidney-pancreas recipients in univariable analysis. Posttransplant anastomosis (HR:4.39; 95%CI:2.49,7.72; padj<0.001) and surgical site/surgical other complications (HR:3.62; 95%CI:2.03,6.46; padj<0.001) were independent risk factors for late IC in univariable analysis for all transplant types. In conclusion, this study highlights the impact of posttransplant Candida colonization and posttransplant surgical complications on the occurrence of IC. These findings can support the design of more effective prophylactic strategies and inform clinical practice in this vulnerable patient population.