Hospital, ICU admissions reduced by early antiviral treatment for H1N1 in organ transplant recipients

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Researchers analyzed data for 237 adults (n=154) and children (n=83) who received organ transplants and contracted influenza A (H1N1) between April 2009 and December 2009. The study was designed to determine the effects of H1N1 and factors leading to severe disease ? measured by admission to hospitals and ICUs ? in transplant patients.

Median time from transplant to symptom onset was 3.6 years (14 days to 21.9 years). Seventy percent of patients were admitted to the hospital a median of 2 days after symptom onset, and 16% were admitted to the ICU a median of 5 days after symptom onset. Twenty-one of 37 patients admitted to the ICU needed mechanical ventilation for a median of 12 days.

Of the 230 patients for whom complication data were available, 32% had pneumonia and 4% died.

Antiviral treatment was used to treat 94% of patients and was more effective when administered within 48 hours of the onset of symptoms. Eight percent of those treated within 48 hours required admission to the ICU compared with 22% who were treated after 48 hours (P=.007). In addition, patients treated early had a lower incidence of hospital admission (P=.049) and need for mechanical ventilation (P=.019).

?Although a formal controlled study in immunocompromised individuals, such as transplant recipients, is still lacking, the results from this and other uncontrolled studies support the use of antiviral drugs in this population,? Per Ljungman, MD, PhD, professor at the Karolinska University Hospital in Stockholm, Sweden, wrote in an accompanying editorial.

According to Ljungman, existing studies among solid organ and stem cell transplant recipients suggest that vaccines are safe and that the benefits of vaccination outweigh the risks associated with influenza infection.

?The experiences from the 2009 pandemic should emphasize the importance of yearly influenza vaccination in these high-risk cohorts,? Ljungman wrote.

Kumar D. Lancet. 2010;doi:10.1016/S1473-3099(10)70133-X.

http://www.pediatricsupersite.com/view.aspx?rid=66329

 

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Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study

Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study

The Lancet Infectious Diseases, Early Online Publication, 9 July 2010
doi:10.1016/S1473-3099(10)70133-XCite or Link Using DOI
Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study
Original Text
Dr Deepali Kumar MD a Corresponding AuthorEmail Address, Prof Marian G Michaels MD b, Michele I Morris MD c, Prof Michael Green MD b, Prof Robin K Avery MD d, Catherine Liu MD e, Lara Danziger-Isakov MD d, Valentina Stosor MD f, Prof Michele Estabrook MD g, Soren Gantt MD h, Prof Kieren A Marr MD i, Stanley Martin MD j, Fernanda P Silveira MD k, Raymund R Razonable MD l, Prof Upton D Allen MBBS m, Marilyn E Levi MD n, G Marshall Lyon MD o, Lorraine E Bell MD p, Shirish Huprikar MD q, Gopi Patel MD q, Kevin S Gregg MD r, Prof Kenneth Pursell MD r, Doug Helmersen MD s, Kathleen G Julian MD t, Kevin Shiley MD u, Bartholomew Bono MD v, Vikas R Dharnidharka MD w, Gelareh Alavi MD x, Jayant S Kalpoe MD y, Shmuel Shoham MD x, Gail E Reid MD z, Atul Humar MD a, on behalf of the American Society of Transplantation H1N1 Collaborative Study Group

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.


http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70133-X/fulltext