*Purpose: Specific food safety measures are highly recommended in solid-organ transplant (SOT) recipients. However, the actual adherence of patients in real life and the impact of these measures on the incidence of foodborne infections remains largely unexplored. Therefore, we aimed to assess the food safety behavior of SOT recipients followed at our institution.

*Methods: We performed a survey among consecutive SOT recipients followed at our institution and transplanted between 01/2012 and 06/2017. Patients were questioned on consumption of food associated with a risk of pathogen contamination and adherence to 4 hygiene and food-handling practice recommendations using an anonymous questionnaire. Answers were scored using a Likert-scale (0-4). Participants were also asked to evaluate the information they received about safety. Finally, knowledge of participants was tested in 6 hypothetical situation commonly faced in all-day life. Incidence of microbiologically documented food-borne infections was assessed by chart review.

*Results: 197/310 (63%) patients responded to the survey [kidney=117, lung=35, liver=29, heart=16]. Median time from transplant was 2.67 years. 77% patients consumed at least one type of risk-associated food occasionally or more frequently. The foods most frequently consumed were raw/undercooked meat products (73% of participants), unpasteurized milk products (70% of participants) and raw egg products (63% of participants). 70% of patients followed all 4 hygiene recommendations all or most of the time. Use of clean utensil for cooked and raw food was not followed most of the time by 14% of the participants. Although 160 participants (81%) declared being appropriately informed about food safety, only 29% of patients were able to identify all high-risk situations. Regular risk-associated food consumption was less frequent (50% vs 25%, P<0.017) and respect of all hygiene rules was more frequent (87% vs 66%, P=0.027) in patients within the first year after transplant. In our cohort, we found one episodes hepatitis E and one case of Campylobacter [incidence of microbiologically-documented food-borne infections was 3.6 (95% CI 0.9-14.3) per 1000 person-year].

*Conclusions: Transplant recipients frequently consume risk-associated food, particularly late after transplantation but follow appropriate measures of food hygiene. This behavior seems not be associated with increased rates of food-borne infections.

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