Invasive mold infection in heart transplant recipients: A nationwide multicenter matched case–control study between 2008 and 2022 in France

Invasive mold infections (IMIs) are rare but severe complications after heart transplantation. This multicenter case-control study aimed to update risk factors and outcomes in this population. Conducted across 14 French centers (2008-2022), it included 120 cases of probable or proven IMIs (European Organisation for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium 2020 criteria) matched to 120 controls, corresponding to the next transplant patient in the same center. Conditional logistic regression identified risk factors for infection, and Cox regression assessed mortality predictors within 90 days. The mean 1 year posttransplant incidence of IMIs was 3.1% (94/3073). The median delay between transplantation and IMI onset was 121 days (Q1-Q3: 43-285) and the 3 month mortality among infected patients was 25% (30/120). In multivariable analysis, age >60 years (adjusted odds ratio [aOR] 2.44, 95% confidence interval [CI]: 1.38-4.32), prolonged intensive care unit stay >15 days (aOR 2.66, 95% CI: 1.24-5.71), and surgical revision (aOR 2.88, 95% CI: 1.04-8.00) were independently associated with IMIs. Among infected patients, hemodialysis (4.57, 95% CI: 2.47-8.45, P < .001) and disseminated infection (adjusted hazard ratio 2.43, 95% CI: 1.25-4.71, P = .009) predicted 90-day mortality. These factors could help identify heart transplant recipients at a higher risk of fungal infections and guide future prophylaxis studies.