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%CI:2.4,3.3) and decreased during the study period (p=0.046). 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 post-transplant (171/262, 65.3%), with Candida albicans being the most common species (181/262, 69.6%), followed by C. glabrata (27.4%, 32/117). 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 one-year post-transplant mortality, especially if it occurred in the first three months (HR:26, 95%CI:14.2,47.4). In conclusion, we report high rates of IC, predominately 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.