TY - JOUR
T1 - Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants
T2 - A multicentre cohort study
AU - Kumar, Deepali
AU - Michaels, Marian G.
AU - Morris, Michele I.
AU - Green, Michael
AU - Avery, Robin K.
AU - Liu, Catherine
AU - Danziger-Isakov, Lara
AU - Stosor, Valentina
AU - Estabrook, Michele
AU - Gantt, Soren
AU - Marr, Kieren A.
AU - Martin, Stanley
AU - Silveira, Fernanda P.
AU - Razonable, Raymund R.
AU - Allen, Upton D.
AU - Levi, Marilyn E.
AU - Lyon, G. Marshall
AU - Bell, Lorraine E.
AU - Huprikar, Shirish
AU - Patel, Gopi
AU - Gregg, Kevin S.
AU - Pursell, Kenneth
AU - Helmersen, Doug
AU - Julian, Kathleen G.
AU - Shiley, Kevin
AU - Bono, Bartholomew
AU - Dharnidharka, Vikas R.
AU - Alavi, Gelareh
AU - Kalpoe, Jayant S.
AU - Shoham, Shmuel
AU - Reid, Gail E.
AU - Humar, Atul
N1 - Funding Information:
DK has received research grants from Roche and Adamas. MIM, AH, UDA, and FPS have each received research grants from Roche. SS has received a research grant from BioCryst. MG has been a consultant for Bristol-Myers Squibb. The remaining authors declare that they have no conflicts of interest.
PY - 2010/8
Y1 - 2010/8
N2 - Background: There are few data on the epidemiology and outcomes of influenza infection in recipients of solid-organ transplants. We aimed to establish the outcomes of pandemic influenza A H1N1 and factors leading to severe disease in a cohort of patients who had received transplants. Methods: We did a multicentre cohort study of adults and children who had received organ transplants with microbiological confirmation of influenza A infection from April to December, 2009. Centres were identified through the American Society of Transplantation Influenza Collaborative Study Group. Demographics, clinical presentation, treatment, and outcomes were assessed. Severity of disease was measured by admission to hospital and intensive care units (ICUs). The data were analysed with descriptive statistics. Proportions were compared by use of χ2 tests. We used univariate analysis to identify factors leading to pneumonia, admission to hospital, and admission to an ICU. Multivariate analysis was done by use of a stepwise logistic regression model. We analysed deaths with Kaplan-Meier survival analysis. Findings: We assessed 237 cases of medically attended influenza A H1N1 reported from 26 transplant centres during the study period. Transplant types included kidney, liver, heart, lung, and others. Both adults (154 patients; median age 47 years) and children (83; 9 years) were assessed. Median time from transplant was 3·6 years. 167 (71%) of 237 patients were admitted to hospital. Data on complications were available for 230 patients; 73 (32%) had pneumonia, 37 (16%) were admitted to ICUs, and ten (4%) died. Antiviral treatment was used in 223 (94%) patients (primarily oseltamivir monotherapy). Seven (8%) patients given antiviral drugs within 48 h of symptom onset were admitted to an ICU compared with 28 (22·4%) given antivirals later (p=0·007). Children who received transplants were less likely to present with pneumonia than adults, but rates of admission to hospital and ICU were similar. Interpretation: Influenza A H1N1 caused substantial morbidity in recipients of solid-organ transplants during the 2009-10 pandemic. Starting antiviral therapy early is associated with clinical benefit as measured by need for ICU admission and mechanical ventilation. Funding: None.
AB - Background: There are few data on the epidemiology and outcomes of influenza infection in recipients of solid-organ transplants. We aimed to establish the outcomes of pandemic influenza A H1N1 and factors leading to severe disease in a cohort of patients who had received transplants. Methods: We did a multicentre cohort study of adults and children who had received organ transplants with microbiological confirmation of influenza A infection from April to December, 2009. Centres were identified through the American Society of Transplantation Influenza Collaborative Study Group. Demographics, clinical presentation, treatment, and outcomes were assessed. Severity of disease was measured by admission to hospital and intensive care units (ICUs). The data were analysed with descriptive statistics. Proportions were compared by use of χ2 tests. We used univariate analysis to identify factors leading to pneumonia, admission to hospital, and admission to an ICU. Multivariate analysis was done by use of a stepwise logistic regression model. We analysed deaths with Kaplan-Meier survival analysis. Findings: We assessed 237 cases of medically attended influenza A H1N1 reported from 26 transplant centres during the study period. Transplant types included kidney, liver, heart, lung, and others. Both adults (154 patients; median age 47 years) and children (83; 9 years) were assessed. Median time from transplant was 3·6 years. 167 (71%) of 237 patients were admitted to hospital. Data on complications were available for 230 patients; 73 (32%) had pneumonia, 37 (16%) were admitted to ICUs, and ten (4%) died. Antiviral treatment was used in 223 (94%) patients (primarily oseltamivir monotherapy). Seven (8%) patients given antiviral drugs within 48 h of symptom onset were admitted to an ICU compared with 28 (22·4%) given antivirals later (p=0·007). Children who received transplants were less likely to present with pneumonia than adults, but rates of admission to hospital and ICU were similar. Interpretation: Influenza A H1N1 caused substantial morbidity in recipients of solid-organ transplants during the 2009-10 pandemic. Starting antiviral therapy early is associated with clinical benefit as measured by need for ICU admission and mechanical ventilation. Funding: None.
UR - http://www.scopus.com/inward/record.url?scp=77955096526&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(10)70133-X
DO - 10.1016/S1473-3099(10)70133-X
M3 - Article
C2 - 20620116
AN - SCOPUS:77955096526
SN - 1473-3099
VL - 10
SP - 521
EP - 526
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 8
ER -