Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population‐based cohort study

Background Invasive fungal infection (IFI) in solid organ transplant (SOT) recipients is associated with significant morbidity and mortality. The long‐term probability of post‐transplant IFI is poorly understood. Methods We conducted a population‐based cohort study using linked administrative healthcare databases from Ontario, Canada, to determine the incidence rate; 1‐, 5‐, and 10‐year cumulative probabilities of IFI; and post‐IFI all‐cause mortality in SOT recipients from 2002 to 2016. We also determined post‐IFI, death‐censored renal allograft failure. Results We included 9326 SOT recipients (median follow‐up: 5.35 years). Overall, the incidence of IFI was 8.3 per 1000 person‐years. The 1‐year cumulative probability of IFI was 7.4% for lung, 5.4% for heart, 1.8% for liver, 1.2% for kidney‐pancreas, and 1.1% for kidney‐only allograft recipients. Lung transplant recipients had the highest incidence rate and 10‐year probability of IFI: 43.0 per 1000 person‐years and 26.4%, respectively. The 1‐year all‐cause mortality rate after IFI was 34.3%. IFI significantly increased the risk of mortality in SOT recipients over the entire follow‐up period (hazard ratio: 6.50, 95% CI: 5.69‐7.42). The 1‐year probability of death‐censored renal allograft failure after IFI was 9.8%. Conclusion Long‐term cumulative probability of IFI varies widely among SOT recipients. Lung transplantation was associated with the highest incidence of IFI with considerable 1‐year all‐cause mortality.