The candidate, John W. Baddley, MD, is an Infectious Disease clinician at the University of Alabama School of Medicine. Through this award he seeks to become an independent investigator in patient-oriented research, with a focus on the epidemiology and outcomes of patients with invasive aspergillosis (IA). Dr. Baddley will be mentored by Dr. Peter G. Pappas, a renowned clinical mycologist, and Dr. O. Dale Williams, an expert biostatistician and outcomes researcher. Together with his mentors and the support of the DAB Department of Medicine, Dr. Baddley will study factors associated with mortality among transplant patients with IA. Dr. Baddley will supplement his research activities with didactics in clinical trial design and conduct, epidemiology and outcomes research, biostatistics, and ethics. This training will result in an MSPH in Epidemiology from the DAB School of Public Health. In addition, he will gain experience in clinical trial conduct by the active enrollment of patients under the guidance of his mentor, Dr. Pappas. Because the incidence of IA has increased in the past several decades and is associated with unacceptably high mortality, there is a great need for investigation into patient outcomes. The project proposed herein will facilitate our understanding of mortality in transplant patients with IA. This will be accomplished using clinical data and Aspergillus isolates collected as part of the Transplant Associated Infection Surveillance Network, of which Dr. Pappas is the principal investigator. Aim 1 will be to define factors associated with mortality in transplant patients with IA by evaluation of prospectively collected data from a cohort of transplant patients. Aim 2 will be to describe the current treatment strategies for IA and assess the impact of Aspergillus species and susceptibility patterns on mortality. These aims have been developed to enhance our knowledge of factors associated with mortality in patients with IA in hopes of identifying patients who may benefit from more aggressive antifungal treatment and prophylaxis and eventually lead to better outcomes.