The Infectious Disease Society of America (IDSA) just released an update to its 2016 guideline regarding aspergillosis. The 2026 clinical practice guideline, Prevention of Invasive Aspergillosis in Adults Solid Organ Transplant Recipients, features recommendations on antifungal prophylaxis for invasive aspergillosis in adult solid organ transplant recipients, which includes heart, lung, pancreas, kidney, or liver, focusing specifically on anti-mold prophylaxis to prevent invasive aspergillosis. 

Below, we have outlined the key recommendations from the 2026 IDSA guideline update, Prevention of Invasive Aspergillosis in Adult Solid Organ Transplant Recipients. Recommendations are separated by organ. Consult the full-text version for a complete look at the clinical practice guideline and rationale behind the recommendations.

Liver Transplant

  • In liver transplant recipients, we suggest against using universal anti-Aspergillus prophylaxis.
  • In liver transplant recipients, we suggest targeted anti-Aspergillus prophylaxis for individuals at high risk of invasive aspergillosis.
  • In liver transplant recipients requiring anti-Aspergillus prophylaxis, we suggest using an echinocandin or a newer anti-mold triazole (voriconazole, posaconazole or isavuconazole) rather than amphotericin B formulations or itraconazole.

Kidney Transplant

  • Given the low pooled incidence of IA, the use of universal anti-Aspergillus prophylaxis is expected to provide limited benefits and thus a less favorable balance of benefits and harms. The current available evidence does not support the use of universal IA prophylaxis in kidney transplant recipients.

Pancreas Transplant

  • Given the low pooled incidence of IA, the use of universal anti-Aspergillus prophylaxis is expected to provide limited benefits and thus a less favorable balance of benefits and harms. The current available evidence does not support the use of universal IA prophylaxis in pancreas transplant recipients.

Lung Transplant

  • In lung transplant recipients, we make no recommendation for or against universal anti-Aspergillus prophylaxis.
  • In lung transplant recipients, we make no recommendation for or against any targeted anti-Aspergillus prophylaxis or preemptive therapy rather than universal anti-Aspergillus prophylaxis.
  • In lung transplant recipients in whom anti-Aspergillus prophylaxis or preemptive therapy is being considered, clinicians should select agent(s) based on the following factors: adverse events profile, drug-drug interactions, ease of administration and tolerability, associated costs and resources, availability, as well as local epidemiology.

Heart Transplant

  • Given the relatively low pooled incidence of IA, the use of universal anti-Aspergillus prophylaxis is likely to offer limited benefits and a less favorable balance of benefits and harms. The current evidence does not support routine universal prophylaxis against IA in heart transplant recipients.

Check out our other infectious diseases content and be sure to sign up for alerts to stay informed on the latest published guidelines and articles.