*Purpose: Oral candidiasis (OC) is a common complication in solid organ transplant recipients. Despite AST guidelines recommending against universal prophylaxis, it has become common practice in many programs. At our center, universal prophylaxis with nystatin is standard of care, duration is organ-dependent based on prednisone dose and generally lasts three to six months. In late 2018, a nationwide nystatin shortage prompted a transition to preemptive monitoring. The aim of this study is to evaluate the incidence of OC within heart and liver transplant recipients in the absence of nystatin prophylaxis.

*Methods: Adult heart and liver transplant recipients transplanted at our center from Jul 1, 2018 to Aug 31, 2019 were retrospectively reviewed. Multi-organ transplant recipients with concomitant lung transplant and those with systemic anti-fungal treatment at discharge were excluded. Data collection included patient demographics, presence and type of prophylaxis at discharge, OC treatment modality and duration, and prednisone dose at OC diagnosis.

*Results: A total of 193 patients met inclusion criteria. Median (IQR) age was 59 years (50-65), 69% were white, and 69% were male. The cohort included: liver transplant recipients (73%), heart transplant recipients (24%), and multi-organ transplant recipients (3%). Fifty-one percent received prophylaxis at time of discharge, most commonly with nystatin (74%). The incidence of OC was similar between those receiving prophylaxis compared to those who were not (1.6% vs. 2.6%). Mean (SD) time to OC diagnosis from transplant was 50 days (±30). All cases of OC were treated, with a mean (SD) duration of 20 days (±9), most commonly with fluconazole (75%). Mean (SD) prednisone dose at time of OC diagnosis was 21 mg (±12).

*Conclusions: Overall, a low incidence of OC was observed. No clinically significant difference was noted between the prophylaxis and the preemptive monitoring groups. Most cases of OC occurred during the standard prophylaxis period at an average prednisone dose of 20 mg. The change to preemptive monitoring due to the nystatin shortage did not negatively impact our transplant population.

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