To compare the incidence of oropharyngeal candidiasis (OC), or thrush, in renal transplant recipients receiving nystatin versus no antifungal prophylaxis.
This was a single-center, retrospective, noninferiority study of adult renal transplant recipients (RTRs) who received nystatin for 30 days for OC prophylaxis (nystatin group) or no antifungal prophylaxis therapy (No PPX group). The primary outcome was the incidence of OC within three months post-transplant. Secondary outcomes included time to OC occurrence and severity of OC. The prespecified noninferiority margin was 10%.
The incidence of OC within three months post-transplant among 257 RTRs was 7.8% (10/128) in the No PPX group and 4.7% (6/129) RTRs in the nystatin group, a risk difference of 3.2% (95% CI, -2.7% to 9.1%, noninferiority p=0.04). The median time to OC was 7.5 days (IQR 6.3 – 34.3 days) in the nystatin group and 9.5 days (IQR 5.3 – 30.5 days) in the No PPX group (p=0.64). Esophageal candidiasis was observed in 10% (1/10) of RTRs with OC in the No PPX group compared to 16.7% (1/6) RTRs in the nystatin group (p=1.00). All RTRs with OC achieved symptom resolution with fluconazole and/or nystatin. Two patients in the No PPX group required readmission for decreased oral intake, and OC was diagnosed and treated during their hospital day.
In this retrospective study of adult RTRs, the absence of antifungal prophylaxis demonstrated noninferiority to 30-day nystatin prophylaxis at reducing the incidence of OC within three months of transplant. OC prophylaxis may not be warranted after renal transplant.

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