Current trends on antifungal prophylaxis in solid organ transplantation: a study from ESCMID-EFISG, ESCMID-ESGICH, SITA, and SEIMC-GESITRA-IC

Introduction: Invasive fungal diseases (IFD) present serious risks to solid organ transplant recipients, particularly in the first 180 days post-transplant. Existing European and US guidelines offer limited evidence, prompting a shift away from universal prophylaxis due to adverse effects, drug-interactions, and costs. This study investigates antifungal prophylaxis practices in transplant centers to guide IFD management. Methods: From May 2023 to May 2024, tertiary care institutions completed an online survey on antifungal prophylaxis post-transplant. Data included transplant volumes, IFD incidence by pathogen, and prophylactic strategies. Results: Responses from 64 centers in 32 countries, mainly in Europe, highlighted kidney and liver as the most common transplants. Prophylaxis was universal in lung transplants and common in liver, bowel, and heart transplants, often triggered by reintervention or Candida spp. colonization. Preferred agents included liposomal amphotericin B and fluconazole. Conclusions: This global survey reveals substantial variation in antifungal prophylaxis practices among solid organ transplant centers, driven by a lack of standardized, evidence-based guidelines. Our findings underscore the urgent need for harmonized recommendations that reflect evolving fungal epidemiology, improved diagnostics, and new antifungal agents.