H1N1 Flu Has Serious Consequences for Organ Transplant Patients

Jim Kling

May 07, 2010

May 7, 2010 (San Diego, California) — H1N1 influenza infection can have serious consequences for solid organ transplant (SOT) patients, according to a study presented here at the American Transplant Congress 2010.

In the midst of the H1N1 flu pandemic of 2009/10, researchers at the University of Alberta, in Edmonton, set out to determine what effect it had on both adult and pediatric SOT recipients. To that end, they conducted a chart review of cases with microbiologically confirmed H1N1 infection between April and November of 2009 in the United States and Canada.

Of the 115 cases identified, 38 were kidney transplants, 23 were liver transplants, 22 were heart transplants, 18 were lung transplants, and 14 involved other organs. Of the study participants, 76 were adults (median age, 49 years) and 39 were children (median age, 8 years). Median time since transplant was 3.8 years (range, 2 weeks to 21.9 years). In all, 61.1% of patients were lymphopenic and 65.2% of patients were hospitalized. Also, 25.2% experienced pneumonia and 13.0% were admitted into the intensive care unit (ICU). One patient died.

Overall, 91.3% of patients received antiviral therapy, typically oseltamivir monotherapy. A multivariate analysis (P < .05) showed that hospitalization was more likely to occur in patients with fever (P < .001), recent antilymphocyte globulin therapy (P = .04), or delayed antiviral therapy (P = .03). Those who received antiviral treatment within 48 hours of symptom onset were less likely to be admitted to the ICU — 0 of 36 patients who received early antiviral treatment were admitted to the ICU, compared with 15 of 67 patients (22.4%) who received late antiviral treatment (= .005).

The researchers concluded that patients with H1N1 are at risk for significant morbidity. "Early antiviral therapy — within 48 hours of symptoms — was associated with less severe disease. Antivirals should be administered [when SOT patients present] with flu-like illness," Deepali Kumar, MD, MSc, FRCPC, assistant professor of medicine at the University of Alberta, said during her presentation of the research.

The findings are encouraging, according to Maryl Johnson, MD, professor of medicine and medical director of the Heart Failure Transplant Program at the University of Wisconsin in Madison, who comoderated the session. "It shows that clinicians can respond effectively and rapidly when the organization structure is in place to allow them to do that," Dr. Johnson told Medscape Transplantation.

The study results should be valuable to clinicians in future outbreaks. "It's a critical study. It's going to guide us the next time this comes around, which it will," Joren Madsen, MD, DPhil, professor of surgery at Massachusetts General Hospital in Boston, and a session comoderator, told Medscape Transplantation.

The study did not receive commercial support. Dr. Kumar has disclosed no relevant financial relationships..

American Transplant Congress (ATC) 2010: Abstract 5. Presented May 2, 2010.

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