Friday, July 09, 2010

H1N1 Can Cause Substantial Illness, Death in Transplant Recipients

Doctor's Guide
NEW YORK -- July 8, 2010 -- Influenza A(H1N1) caused substantial disease and death in solid organ transplant (SOT) recipients during 2009-2010. However, early treatment (within 48 hours) with antiviral therapy resulted in lower rates of hospitalization and reduced the number of admissions to intensive care by almost two-thirds.

Wherever possible, early antiviral treatment for symptomatic patients during future outbreaks along with preventive measures such as vaccination might offer protection for this high risk population, according to a study published online first and appearing in an upcoming print issue of The Lancet Infectious Diseases.

Transplant recipients infected with H1N1 are probably more likely to develop severe disease than the general population. Although many guidelines document the importance of influenza infection in organ transplantation, studies on the impact of influenza and the use of antiviral treatment in SOT patients are lacking. In addition, conflicting outcomes have been reported about the severity of disease resulting from influenza infection.

To provide more evidence on clinical outcomes in people who have had a SOT, Deepali Kumar, MD, University of Alberta, Edmonton, Alberta, and colleagues assessed 237 transplant recipients infected with H1N1 to identify factors leading to admission to hospital and intensive care unit (ICU), and other complications.

The researchers surveyed 154 adults and 83 children from 26 transplant centers in the US, Canada, and Europe who had received organ transplants (kidney, heart, lung, liver, and others) and had H1N1 between April and December 2009. Information on type of transplant, symptoms, diagnosis, and treatment were collected, and factors leading to pneumonia, admission to hospital, and ICU were calculated using statistical models.

Patients received their transplant a median 3.6 years before being infected with H1N1. Overall, 167 (71%) of 237 patients were admitted to hospital, 37 (16%) were sent to the ICU (of whom 21 needed mechanical ventilation), and 10(4%) died.

Importantly, findings showed that early antiviral treatment, primarily with oseltamivir, was linked with a reduced likelihood of ICU admission (7 of 90 patients treated within 48 hours vs 28 of 125 patients treated after 48 hours), admission to hospital, need for mechanical ventilation, and death.

The results confirmed previous research showing a high risk of pneumonia, with almost a third of patients in this study contracting pneumonia. Interestingly, children were less likely to present with pneumonia compared with adults (13 of 81 children vs 60 of 149 adults).

"Pandemic influenza A H1N1 resulted in a spectrum of illness ranging from mild and self-limiting to severe disease in recipients of solid-organ transplants…starting treatment with antiviral drugs early is important for reduction of morbidity and mortality in this highly susceptible population," the authors wrote. "For example, during periods of transmission, transplant patients presenting with signs and symptoms that are compatible with influenza should probably start empirical treatment with antiviral drugs before the diagnosis is confirmed."

"Almost a third of the patients in our cohort reported contact with an ill household member before their own illness," they continued. "In this setting, postexposure chemoprophylaxis might be an option…Vaccination of both transplant patients and their household contacts is probably an important preventive measure since vaccine responses might be suboptimum after transplantation."

SOURCE: The Lancet Infectious Diseases

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