What question did this study set out to answer?

This analysis aims to evaluate the receipt of pretransplant fungal infection testing among solid organ and hematopoietic cell transplant recipients.

February 26, 2026

Pretransplant serologic testing for fungal infections in a large commercial health insurance database, United States

Key Points

This analysis aims to evaluate the receipt of pretransplant fungal infection testing among solid organ and hematopoietic cell transplant recipients.
Exploratory analysis using a large U.S. commercial health insurance database.
Identified patients who received solid organ transplantation or hematopoietic cell transplantation from 2018 to 2025.
Evaluated pretransplant testing practices for selected fungal and non-fungal infections in the year before transplantation.
8.9% of solid organ transplant recipients received pretransplant fungal testing.
13.0% of hematopoietic cell transplant recipients received pretransplant fungal testing.
Coccidioides antibody testing was most frequent among SOT recipients (5.0%), especially in endemic states like Arizona (58.7%).
Cryptococcal antigen testing was the most common among HCT recipients (5.2%).
Rates of viral and tuberculosis testing were significantly higher than fungal testing.

Abstract

Abstract Reactivation of latent fungal infections poses a substantial risk for solid organ transplantation (SOT) and hematopoietic cell transplantation (HCT) recipients. We describe receipt of pretransplant fungal infection testing in an exploratory analysis among patients in a large U.S. commercial health insurance database. We identified patients who received a SOT or HCT during January 1, 2018–January 31, 2025 and evaluated testing practices for selected fungal (blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis) and non-fungal infections (including hepatitis B virus HBV, hepatitis C virus HCV, HIV, cytomegalovirus CMV, tuberculosis) in the year before transplantation. In total, 8.9% of 11,362 SOT and 13.0% of 6,934 HCT recipients received pretransplant fungal testing. Among SOT recipients, Coccidioides antibody was the most frequent fungal test type (5.0%), with the highest rates in states with known endemicity (e.g., Arizona: 58.7%). Among HCT recipients, cryptococcal antigen testing was the most common fungal test type (5.2%). Testing rates for viral infections and tuberculosis were substantially higher compared with fungal infection testing: HBV (SOT: 65.1%, HCT: 73.4%), HCV (SOT: 55.8%, HCT: 71.1%), HIV (SOT: 45.5%, HCT: 66.3%), CMV (SOT: 41.7%, HCT: 65.9%), and tuberculosis (SOT: 38.0%, HCT: 16.8%). Pretransplant fungal infection testing was infrequently performed compared with recommended viral and tuberculosis screening, consistent with current guidelines. Further research to understand the clinical outcomes and cost-effectiveness associated with pretransplant fungal testing could help improve approaches for targeted screening.

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