Endemic fungi can cause severe infections in solid organ transplant recipients. This retrospective review from 3 transplant centres reviews the presentation and management of 30 solid organ transplant recipients with histoplasmosis or blastomycosis between 1998 and 2008, noting an incidence of infection of 0.5%. The majority of the patients were renal transplants. Time of onset was variable, with 20% of cases occurring 5 or more years post transplant. Pulmonary infections were the most common (83%), and disseminated disease was very common (60%). Although the incidence was low, overall mortality was high at 30%.