*Purpose: Oropharyngeal candidiasis (OC), or thrush, is a fungal infection associated with immunosuppression post renal and or/pancreas transplant. Currently, the role of prophylactic oral nystatin for OC is controversial as incidence is variable. This study compares the incidence of OC within 3 months post renal and/or pancreas transplant in patients receiving 0, 1, or 3 months of oral nystatin.

*Methods: This study was a retrospective analysis of patients who underwent kidney and/or pancreas transplant between August 2018 and March 2020. Exclusion criteria included: alternative antifungal agent used for prophylaxis (ie: clotrimazole, fluconazole), the use of antifungal therapy for indication other than OC, and death within 3 months post-transplant. The primary outcome compared incidence of OC development after receiving no prophylaxis, 1 month, or 3 months of nystatin prophylaxis. Secondary outcomes include time to OC, severity of OC and readmission rates due to OC.

*Results: A total of 238 patients met inclusion criteria, 68 received no nystatin prophylaxis, 87 received 3 months of prophylaxis, and 83 received 1 month of prophylaxis (Table 1). Baseline characteristics were similar between groups with the majority of patients receiving ATG induction and tacrolimus with mycophenolate sodium for maintenance immunosuppression. There was a greater incidence of OC in the no prophylaxis group compared to 1 month and 3 months of prophylaxis (5.9% vs 0% vs 0%). Three out of four patients developed OC within 30 days post-transplant. Patient 2 was readmitted for OC, while Patient 3’s index admission was extended due to OC (Table 2). Of the patients being treated for OC, none worsened to esophagitis.

*Conclusions: Given the low incidence of OC infections post-transplant and concern for patient adherence, a shortened duration of 1 month of nystatin prophylaxis is reasonable to decrease the occurrence of OC. Given the small sample size, further evaluation of 1 month OC prophylaxis versus no prophylaxis should be considered.

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