A 5-year prospective multicenter evaluation of influenza infection in transplant recipients

Deepali Kumar, Victor H. Ferreira, Emily Blumberg, Fernanda Silveira, Elisa Cordero, Pilar Perez-Romero, Teresa Aydillo, Lara Danziger-Isakov, Ajit P. Limaye, Jordi Carratala, Patricia Munoz, Miguel Montejo, Francisco Lopez-Medrano, Maria Carmen Farinas, Joan Gavalda, Asuncion Moreno, Marilyn Levi, Jesus Fortun, Julian Torre-Cisneros, Janet A. EnglundYoichiro Natori, Shahid Husain, Gail Reid, Tanvi S. Sharma, Atul Humar

Research output: Contribution to journalArticlepeer-review

134 Scopus citations

Abstract

Background Seasonal influenza infection may cause significant morbidity and mortality in transplant recipients. The purpose of this study was to assess the epidemiology of symptomatic influenza infection posttransplant and determine risk factors for severe disease. Methods Twenty centers in the United States, Canada, and Spain prospectively enrolled solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT) recipients with microbiologically confirmed influenza over 5 consecutive years (2010-2015). Demographics, microbiology data, and outcomes were collected. Serial nasopharyngeal swabs were collected at diagnosis and upto 28 days, and quantitative polymerase chain reaction for influenza A was performed. Results We enrolled 616 patients with confirmed influenza (477 SOT; 139 HSCT). Pneumonia at presentation was in 134 of 606 (22.1%) patients. Antiviral therapy was given to 94.1% for a median of 5 days (range, 1-42 days); 66.5% patients were hospitalized and 11.0% required intensive care unit (ICU) care. The receipt of vaccine in the same influenza season was associated with a decrease in disease severity as determined by the presence of pneumonia (odds ratio [OR], 0.34 [95% confidence interval {CI},.21-.55], P <.001) and ICU admission (OR, 0.49 [95% CI,.26-.90], P =.023). Similarly, early antiviral treatment (within 48 hours) was associated with improved outcomes. In patients with influenza A, pneumonia, ICU admission, and not being immunized were also associated with higher viral loads at presentation (P =.018, P =.008, and P =.024, respectively). Conclusions Annual influenza vaccination and early antiviral therapy are associated with a significant reduction in influenza-associated morbidity, and should be emphasized as strategies to improve outcomes of transplant recipients.

Original languageEnglish
Pages (from-to)1322-1329
Number of pages8
JournalClinical Infectious Diseases
Volume67
Issue number9
DOIs
StatePublished - 15 Oct 2018
Externally publishedYes

Keywords

  • antiviral therapy
  • outcome
  • pneumonia
  • vaccine
  • viral infection

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