*Purpose: Fungal infections after pancreas transplantation have been associated with morbidity and mortality, therefore transplant centers may elect to use systemic perioperative antifungal prophylaxis (ppx). Many guidelines and authors suggest using systemic antifungal ppx in pancreas transplant recipients (PTRs), however these recommendations are based on limited clinical evidence. As our program does not routinely utilize systemic perioperative antifungal ppx in PTRs, we assessed the impact of no systemic antifungal ppx use on the incidence of post-transplant infectious complications.

*Methods: A single-center, retrospective cohort study of consecutive adult PTRs between 01/2016 and 04/2018 was conducted to describe the incidence of fungal infections without the use of systemic perioperative antifungal ppx. Patients with a history of previous simultaneous pancreas-kidney (SPK) transplant, HIV, or unexplained use of empiric antifungal ppx were excluded. The primary outcome was the incidence of fungal infections, defined as a positive fungal culture requiring systemic antifungal treatment within three months after transplantation. Other secondary endpoints included incidence of fever of unknown origin and allograft-related outcomes.

*Results: After screening 60 PTRs, 56 patients met inclusion criteria. Within three months post-transplantation, two (3.6%) patients had a positive fungal culture requiring systemic antifungal treatment. The sources for infection in both cases were intra-abdominal fluid cultures, found on postoperative day 8 and 17, positive for Candida albicans. Both patients were treated with fluconazole for a duration of 10 days. Furthermore, allograft related outcomes included a 6-month pancreas graft survival of 91.1% and pancreas transplant rejection incidence of 10.7%. Other secondary outcomes are described in Table 1.

*Conclusions: In this single-center experience of a large volume pancreas transplant program, PTRs not receiving systemic antifungal ppx may have similar infectious and graft related outcomes to what is reported in pancreas transplant literature. The absence of systemic antifungal ppx around the time of transplant avoids significant drug-drug interactions with immunosuppression medications and may minimize future azole resistance. Randomized, controlled trials with a larger sample size and comparator group are warranted to further address whether systemic antifungal ppx in PTRs is indicated.

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