Pandemic Influenza A/H1N1 Virus Infection in Solid Organ Transplant Recipients: A Multicenter Study

Smud, Astrid1; Nagel, Claudia B.2; Madsen, Elizabeth2; Rial, María del C.3; Barcán, Laura A.1; Gomez, Abel A.4; Martinoia, Andrea G.5; Bangher, María C.6; Altclas, Javier D.7; Salgueira, Claudia C.7; Temporiti, Elena8; Bonvehi, Pablo E.8; Enriquez, Natalia9; Efron, Ernesto D.9; Bibolini, Julián E.10; Lattes, Roberta11,12

doi: 10.1097/TP.0b013e3181fc09fe
Clinical and Translational Research

Background. The 2009 novel influenza A/H1N1 virus pandemic did not spare solid organ transplant (SOT) recipients. We aimed to describe the behavior of pandemic influenza infection in a group of SOT recipients in Argentina.

Methods. Data from 10 transplant (Tx) centers were retrospectively collected for SOT that presented with a respiratory illness compatible with pandemic influenza A infection, between May and September 2009. Cases were defined as suspected, probable, or confirmed according to diagnostic method.

Results. Seventy-seven cases were included. No significant differences in presenting symptoms, pulmonary infiltrates, and graft involvement were found among 35 suspected, 19 probable, and 23 confirmed cases. The 33 ambulatory cases had significantly more sore throat and headache when compared with 34 cases admitted to medical ward (MW) and 10 admitted to intensive care unit (ICU), 9 of whom required ventilatory support. MW and ICU cases had significantly more dyspnea, hypoxemia, pulmonary infiltrates, and graft dysfunction. Time from onset of symptoms to first visit and to treatment was significantly longer in MW and ICU cases (P=0.008). Coinfections were found in six cases. Most cases received oseltamivir for 5 to 10 days. Six patients (7.8%) died from viral infection at a median of 15 days from admission. No differences in outcome were seen related to the transplanted organ, the immunosuppressive regimen, time from Tx, or confirmation of diagnosis.

Conclusions. Mortality is higher in Tx recipients than in the general population. Poor outcome seems to be related to a delay in the beginning of treatment.

1 Infectious Disease Section, Internal Medicine, Hospital Italiano, Buenos Aires, Argentina.

2 Department of Epidemiology and Infectious Diseases, Hospital Universitario de la Fundación Favaloro, Buenos Aires, Argentina.

3 Kidney Transplant Unit, Instituto de Nefrología Nephrology, Buenos Aires, Argentina.

4 Infectious Disease Section, Clinica de Nefrologia, Urologia y Enfermedades Cardiovasculares, Santa Fe, Argentina.

5 Kidney Transplant Unit - HIGA San Martín, CUCAIBA, La Plata, Buenos Aires, Argentina.

6 Infectious Disease Unit, Instituto de Cardiología de Corrientes J F Cabral, Corrientes, Argentina.

7 Infectious Disease and Infection Control Unit, Sanatorio Trinidad Mitre, Buenos Aires, Argentina.

8 Infectious Disease Section, Department of Internal Medicine, CEMIC (Centro de Educación Médica e Investigaciones Clínicas), Buenos Aires, Argentina.

9 Infectious Disease Unit - Hospital Británico, Buenos Aires, Argentina.

10 Infectious Disease and Infection Control Unit, Department of Clinical Management, Hospital de Alta Complejidad Presidente Juan D Perón, Formosa, Argentina.

11 Infectious Disease Unit, Department of Transplantation, Instituto de Nefrología Nephrology, Buenos Aires, Argentina.

M.d.C.R. serves as a member of the Advisory Board of Novartis, Wyeth, and Pfizer and received research grants from Bristol Meyer Squib, Roche, Novartis, and Wyeth. P.E.B. serves as a member of the Advisory Board of GlaxoSmithKline and served as a speaker for Roche, Novartis, and Sanofi-Pasteur.

The authors declare no conflict of interest.

12 Address correspondence to: Roberta Lattes, M.D., Zavalía 2040, Buenos Aires 1428, Argentina.

E-mail: roberta.lattes@gmail.com

C.B.N., L.A.B., C.C.S., and R.L. participated in study design and interpretation of data; A.S., C.B.N., L.A.B., C.C.S., and R.L. participated in data analysis and statistics; C.B.N., L.A.B., and R.L. participated in manuscript preparation; and all authors have participated in the collection of data and in the review of the manuscript.

Received 2 August 2010.

Accepted 12 September 2010.

© 2010 Lippincott Williams & Wilkins, Inc.