*Purpose: Antifungal prophylaxis is recommended for Aspergillus colonization within a year in lung transplant recipients (LTRs) to prevent invasive aspergillosis (IA). However, the rate of IA in LTRs colonized beyond a year after transplantation is not known. This information may be helpful in devising antifungal preventive strategies.

*Methods: We retrospectively identified LTRs from January 2010 to September 2017 who had Aspergillus colonization detected in broncho-alveolar lavage (BAL) fluid beyond the first year post-transplant. All the patients were followed for the development of IA for one year after colonization. Rates of IA development were compared between patients who received and did not receive antifungal prophylaxis using the fisher’s exact test. ISHLT definitions were used to define IA and colonization.

*Results: We identified 75 LTRs with Aspergillus colonization beyond 1 year after lung transplant. Aspergillus fumigatus was the most common species (48.8%). In these patients, the median time to colonization after lung transplant was 559 days. Out of the 75 LTRs, 14 (18.7%) received antifungal prophylaxis starting a mean of 20.6 days after BAL, of whom 12 (85.7%) received voriconazole, and one (7.1%) developed IA. 61/75 (81.3%) did not received antifungal prophylaxis, and 4 (6.5%) developed IA (P=0.65). The median time to diagnosis of IA after colonization was 119 days. Rejection within 90 days prior to colonization reported in 3 patients. All of them received antifungal prophylaxis and none developed IA. One-year mortality after Aspergillus colonization was 4/75 (5.3%), with no death due to IA

*Conclusions: 7% of LTRs with Aspergillus colonization more than one year after lung transplantation developed IA in the subsequent year. Identification of risk factors resulting in IA may help direct targeted prophylaxis

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