5-year Review of Invasive Fungal Diseases in a National Heart Transplant Centre

Purpose Antifungal prophylaxis in heart transplantation is not universally prescribed in our institution. We reviewed the incidence of invasive fungal diseases (IFD) in heart transplants, risk factors, and diagnostic yield of culture and nonculture-based testing for IFD. Methods A 5-year retrospective audit of heart transplant recipients in a national transplant centre from 2015 to 2019 was conducted. Proven and probable IFD were identified based on host factors, clinical features and mycological evidence outlined by the updated EORTC/MSGERC definitions. Results The incidence of proven or probable IFD was 14% (11/77) with 207 median days (IQR 54.5-306) post-transplant to diagnosis. 4 (36%) cases occurred 0.05). Of the 7 with rejection, median time from transplant to 1st rejection was 17 days (IQR11-51), and 1st rejection to IFD was 125 days (IQR 44-191). 45% (5/11) with IFD had required post-operative renal replacement therapy. 45% had neutrophils Conclusion Antifungal surgical prophylaxis could have prevented 1 IFD. A cohort of high-risk heart transplant recipients may benefit from antifungal prophylaxis.