*Purpose: This study aims to determine the effect of micafungin, added as a bridging agent to azole antifungal prophylaxis, in lung transplantation patients with positive Candida respiratory cultures in the first 6 weeks post-transplant.

*Methods: This is a single-center, retrospective cohort study conducted via chart review of lung transplant recipients between August 2017 and August 2020. Included patients were adult lung transplant recipients with positive Candida cultures pre-operatively (donor or recipient) or within 6 weeks post-operatively. Patients were divided into 2 cohorts: historical cohort with azole monotherapy and current cohort, where our institutional protocol included a micafungin bridge until azole levels are in therapeutic range whenever a respiratory culture is positive for Candida.

The primary outcome was a composite of proven or probable invasive fungal infections defined by the Revised 2020 European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Secondary outcomes included proven invasive fungal infections, probable invasive fungal infections, any adverse bronchoscopy finding (i.e., anastomotic dehiscence, sloughing, or severe ischemia/necrosis), sternal wound dehiscence, bacterial and/or fungal chest wall infection, fungal empyema, intensive care unit length of stay, post-transplant hospital length of stay, and 90-day all-cause mortality.

*Results: A total of 117 patients were included in the study: 68 in the unbridged cohort and 49 in the bridged cohort. The two cohorts appear similar; however, 32.7% of patients in the bridged group required extracorporeal membrane oxygenation, compared to 16.2% in the unbridged group.

*Conclusions: In combination with an azole antifungal, micafungin did not prevent invasive fungal infections in post-operative lung transplant patients with cultures positive for Candida species.

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