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. 2025 Sep-Oct;27(5):e70077.
doi: 10.1111/tid.70077. Epub 2025 Jul 8.

Invasive Fungal Disease in Solid Organ and Hematopoietic Cell Transplant Recipients, United States

Jeremy A W Gold  1 , Kaitlin Benedict  1 , Elizabeth Sajewski  1 , Tom Chiller  1 , Meghan Lyman  1 , Mitsuru Toda  1 , Jessica S Little  2   3 , Luis Ostrosky-Zeichner  4
Affiliations

Invasive Fungal Disease in Solid Organ and Hematopoietic Cell Transplant Recipients, United States

Jeremy A W Gold et al. Transpl Infect Dis. 2025 Sep-Oct.

Abstract

Background: Updated benchmark data on invasive fungal disease (IFD) in solid organ transplantation (SOT) and hematopoietic cell transplantation (HCT) recipients are necessary to increase clinical recognition and inform treatment and prevention strategies. We estimated IFD incidence and potential risk factors in transplant recipients in a large US commercial health insurance database.

Methods: We observed patients who received SOT or HCT during 2018-2022 until IFD development, disenrollment, or database end date (July 31, 2023). We calculated incidence (per 1000 person-years) and time to IFD development, comparing demographic features and underlying conditions for IFD versus non-IFD patients.

Results: Overall, 9143 patients received an SOT (5667 kidney, 2025 liver, 759 heart, 650 lung, 39 pancreas, 3 intestine), and 5693 patients received an HCT (3519 autologous, 2114 allogeneic, 60 unspecified type). Among SOT patients, 360 developed an IFD (incidence: 21.0 [per 1000 person-years]). Mold infections had the highest incidence (7.1), followed by unspecified mycoses (3.9) and endemic mycoses (3.3). Among HCT patients, 292 developed an IFD (incidence: 28.5), with higher incidence among allogeneic (58.4) versus autologous (12.8) HCT recipients; among all HCT recipients, unspecified mycoses had the highest incidence (8.3), then pneumocystosis (7.6), and mold infections (6.7). Median time to IFD was 173.5 days for SOT recipients and 197.5 days for HCT recipients. IFD risk varied substantially by transplant type, region, and certain underlying conditions.

Conclusion: Our results suggest that IFDs remain an important cause of infection among SOT and HCT recipients, particularly later in the posttransplant period, and highlight the need for prevention strategies.

Keywords: aspergillosis; candidiasis; cryptococcosis; invasive fungal disease; pneumocystosis; solid organ transplantation; stem cell transplantation.

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Conflict of interest statement

Conflicts of Interest

Pertinent to this work, Luis Ostrosky-Zeichner has received research grants and/or consulting honoraria from the following companies: Scynexis, Melinta, GSK, Pulmocide, F2G, Basilea, Pfizer, Gilead, T2 Biosystems, and Eurofins Viracor. He is partially funded by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through UTHealth-CCTS Grant Number UL1TR003167 and contract U01CK000692, Centers for Disease Control and Prevention. The other authors declare no conflicts of interest.

Figures

FIGURE 1 ∣
FIGURE 1 ∣
Days between transplantation and invasive fungal disease (IFD) development among solid organ transplant recipients, by transplant type (A) and by IFD type (B), and among hematopoietic cell transplant recipients, by transplant type (C) and by IFD type (D). Box and whisker plots showing the number of days between transplantation and the development of invasive fungal disease (IFD) among solid organ transplant recipients categorized by transplant type (panel A) and IFD type (panel B). In addition, box and whisker plots for hematopoietic cell transplant recipients show the days to IFD development by transplant type (panel C) and IFD type (panel D). Each plot displays median values, interquartile ranges, and potential outliers.
See this image and copyright information in PMC

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