2025 Southeastern Residency Conference

Title: Incidence of oral candidiasis post kidney transplant in patients with or without oral nystatin prophylaxis 
Authors: Hannah Green, Alexandra Pyatt, Lindsay Reulbach, Rachel Gustafson, Carlos Zayas, and Alex Ewing 
 
Background: Renal transplant recipients (RTRs) are at increased risk for fungal infections, particularly oral candidiasis (OC), due to maintenance immunosuppression. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend 1-3 months of fungal prophylaxis with oral fluconazole, clotrimazole troches, or nystatin suspension. However, the American Society of Transplantation does not endorse routine Candida prophylaxis. The necessity of fungal prophylaxis is questioned given the low incidence of OC, ease of treatment, and potential non-adherence to nystatin. The purpose of this study aimed to evaluate the incidence of OC within 60 days post-transplant in patients with and without 30-day nystatin prophylaxis. 
 
Methods: A single-center, retrospective study was conducted at Prisma Health Greenville Memorial Hospital in patients 18 years or older who underwent a single renal transplant between July 2023 and January 2024 (with prophylaxis) and February 2024 to August 2024 (without prophylaxis). Exclusion criteria included concomitant use of systemic antifungals, antifungal use within 30 days prior to transplant, a history of OC, or a history of prior transplant or dual organ transplant. The primary outcome was the incidence of OC within the first 60 days post-transplant. Secondary outcomes included the occurrence of esophageal candidiasis (EC), systemic fungal infections, inpatient readmissions for OC, and the duration of OC treatment. 
  
Results: A total of 173 transplant patients were screened and 132 were included in the final analysis with 64 in the without prophylaxis group and 68 in the prophylaxis group. At baseline, more patients in the prophylaxis group were on tacrolimus and mycophenolate maintenance regimens, had steroids withdrawn, and used fewer additional steroids. The incidence of OC was similar between groups, with two cases in each (2.9% vs. 3.1%, p=1.000), all of which were treatable. None of the secondary outcomes were statistically significant, though two cases of EC occurred in the prophylaxis group. Only one patient in the prophylaxis group required readmission for OC, and both OC cases in the without prophylaxis group involved additional steroid use. 
 
Conclusions: The findings of this study demonstrate that the incidence of OC was low and, when it occurs, was easily treatable. There was no statistically or clinically significant difference in OC incidence between the prophylaxis and without prophylaxis groups, despite the latter group being more immunosuppressed. Given the comparable rates of OC between the two groups, nystatin prophylaxis does not appear to be warranted in this transplant population. Therefore, no modifications to current clinical practices are recommended.