Scedosporium apiospermum/aurantiacum and Lomentospora prolificans (S/L) can cause life threatening fungal infection after lung transplant (LTx). Our aims were to report the prevalence of S/L in bronchoalveolar lavage (BAL) after LTx, identify risk factors and review survival. A retrospective cohort study was performed on all LTx 2001-2020 at St Vincent's Sydney. All post-LTx BAL samples were reviewed for S/L. Invasive S/L vs colonisation was determined. Baseline recipient and donor characteristics, presence of chronic lung allograft dysfunction (CLAD), cumulative A-grade rejection and cumulative infection scores were recorded. Multivariable logistic regression was performed to identify independent risk factors associated with S/L development. Kaplan Meier curves for post-S/L survival for invasive vs colonisation of S/L were compared using a log-rank test. Of 848 LTx recipients, S/L were identified in 63 (7.4%); 28 (3.3%) S. apiospermum, 37 (4.4%) L. prolificans , 2 (0.2%) S. aurantiacum. 4 (0.4%) patients had >1 S/L species concurrently. Median time after transplant to first S/L identification was 2.2 years (Interquartile range (IQR) 5.1). Of patients with S/L, 25 (40%) had probable invasive disease, 35 (56%) had a concomitant BAL pathogen at time of S/L identification and 62 (98%) received azole antifungals.In multivariable logistic regression analysis donor age (aOR 1.02, 95% CI 1.01-1.04, p=0.03), CLAD (aOR 3.42, 95% CI 1.85-6.4, p<0.01) and cumulative infection score (aOR 9.87, 95% CI 3.84-25.36, p<0.01) were independently associated with S/L identification. Of 46 patients who had both S/L and CLAD, 24 (52%) developed CLAD prior to S/L. Death occurred in 35 (56%) patients with S/L with median time to death after S/L identification of 1.4 years (IQR 3.3). There was a significant difference in post-S/L Kaplan-Meier survival curves for recipients with invasive S/L compared with colonisation. (HR 2.2 CI 1.1-4.9 p=0.01) S/L is commonly detected in LTx recipients and its presence is independently associated with CLAD, donor age and higher rates of other respiratory pathogens. There is no clear temporal relationship between S/L identification and CLAD development. Survival following invasive disease is reduced compared to colonisation despite the use of azole antifungals. [ABSTRACT FROM AUTHOR]