P-2158. Early Candida Isolation and Long-Term Survival After Lung Transplantation: Species-Specific Risks and Predictors

TL;DR

Early isolation of Candida species, especially C. glabrata, after lung transplantation is linked to worse long-term survival, with certain pre-transplant conditions increasing infection risk.

Contribution

Identifies species-specific risks and predictors of Candida infection and mortality in lung transplant recipients.

Findings

Candida isolation within one year post-transplant is associated with significantly poorer survival (adjusted hazard ratio: 1.6).

C. glabrata isolated within 30 days increases mortality risk by 2.1-fold.

Pre-transplant myocardial infarction and liver disease are significant predictors of early C. glabrata infection.

Abstract

Candida species are common nosocomial or donor-derived fungal pathogens in lung transplant recipients, but their impact on outcomes, including species-specific variation, remain unclear. Given evolving fungal epidemiology, we evaluated the association between early Candida isolation with post-transplant survival, and clinical predictors of infection.

We conducted a retrospective cohort study of incident lung transplant recipients at a tertiary-care center between 2010 to 2024. Eligible recipients were identified by procedural codes and associated hospitalization. Post-transplant Candida isolation was defined as any culture-positive isolation using microbiology and susceptibility testing reports. Follow-up began on the date of lung transplant, and the primary outcome was 10-year overall survival. Cox proportional hazards models, adjusted for demographics and transplant-specific factors, were applied to assess differences in pathogen isolation and survival. Logistic regression identified pre-transplant predictors of Candida isolation.

Among 463 lung transplant recipients, adjusted mortality rates were 7.3% (n=34) at 1 year and 58.0% (n=160) at 10 years post-transplant, with a median follow-up of 5.3 years. Candida was documented in 45 (9.7%) and 66 (14.3%) recipients within 30 days and 1 year after transplant, respectively. Most common Candida species were C. glabrata (n=31, 6.7%), C. parapsilosis (n=15, 3.2%), and C. albicans/dubliniensis (n=14, 3.0%). No C. auris was identified. Those with Candida isolation within 1 year after transplant had a significantly poorer survival (adjusted hazard ratio: 1.6, 95%CI: 1.0–2.5, p = 0.041). C. glabrata isolated within 30 days was associated with 2.1-fold increased risk of mortality (95%CI:1.1-4.0, p=0.026). Pre-transplant predictors of C. glabrata isolation within 30 days include history of myocardial infarction (adjusted odds ratio [aOR]: 7.7, p=0.012) and moderate/severe liver disease (aOR: 5.9, p=0.016).

Candida isolation, particularly early C. glabrata, may be associated with reduced post-transplant survival. Specific baseline comorbidities predicted risk of infection. Future research will evaluate the impact of antifungal prophylaxis strategies on clinical outcomes.

Kathryn DeSear, PharmD, Abbvie: Advisor/Consultant|Biomerieux: Advisor/Consultant|Cormedix: Speaking|GSK: Advisor/Consultant|Shionogi: Speaking