Reply to Heldman et al

We appreciate Heldman and colleagues' interest in our study [1,2], highlighting the challenges involved in research of fungal infections, and allowing us to clarify some key points.Although not expressly written due to word count restraints, we assure that the standardized definitions from the most recent European Organization for the Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) were used to classify our cases [3].Our decision to include cases of possible Invasive Fungal Diseases (IFD) was based on thorough chart reviews where there was compelling evidence justifying the treatment of fungal infection, even if these infections did not strictly meet the criteria of probable or proven.By adopting this approach, we aimed to capture a broader spectrum of clinically significant cases.Additionally, the studies we referenced to elucidate the incidence of fungal infections in solid organ transplant (SOT) recipients on belatacept did not explicitly communicate this "proven, probable, possible" schema, which would have provided clarity regarding the confidence level of fungal infection diagnosis.As underscored by Heldman and colleagues, discriminating between airway colonization and invasive pulmonary or tracheobronchial infections presents inherent challenges in retrospective reviews.