Influenza, including the novel H1N1, in organ transplant patients.
OBJECTIVE
This article will review the epidemiology, diagnosis, prevention and management of influenza in solid organ transplant recipients.


RESULTS
A number of recent studies have documented that influenza vaccination is both well tolerated and generally effective in producing an immunologic response in most solid organ transplant (SOT) recipients. Antiviral use is associated with improved clinical outcomes, but prolonged shedding may require a longer course of therapy than what is currently approved by the FDA. Antiviral resistance emerges rarely in transplant patients and should be considered in all patients with an inadequate clinical and/or virologic response.


CONCLUSIONS
Influenza is associated with significant morbidity and mortality, particularly in lung transplant recipients. Molecular diagnostics are preferred over other diagnostic modalities, if available. Influenza vaccination is well tolerated and provides protective benefit in most SOT recipients; in those with contraindications to vaccination or in whom responses are predicted to be poor, antivirals may be considered. Antiviral therapy is associated with improved outcomes in transplant patients and treatment should be continued until clinically and virologic response have been documented. Resistance, particularly with patients infected with the pandemic influenza A/H1N1, should be considered and treated with an antiviral with predicted activity.
Ison
Michael G
MG
Divisions of Infectious Diseases & Organ Transplantation, Comprehensive Transplant Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA. mgison@northwestern.edu
D000998:Antiviral Agents / Q000627:therapeutic use; D024882:Drug Resistance, Viral; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000627:therapeutic use; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000517:prevention & control / Q000821:virology
D000998:Antiviral Agents; D007252:Influenza Vaccines