title: Correlations between A/H1N1 influenza and acute cellular rejection in liver transplantation patients.
abstract: BACKGROUND
  Influenza is a common cause of respiratory infection in transplant recipients. It is expected that A/H1N1 influenza virus causes more severe disease in solid-organ recipients. Our goal was to describe two A/H1N1 infections that occurred after Orthotopic liver transplantation followed by acute allograft rejection episodes.
  
  
  METHODS
  From March 2009 to March 2010 we observe two liver transplant patients with symptoms suggestive of A/H1N1 infection. The diagnosis was out based on a temperature of 37.8°C (100°F) or higher and the presence of a cough or using materials from anasopharyngeal and oropharyngeal swabs a sore throat. The diagnosis was confirmed by viral RNA detection by real-time reverse-transcriptase-polymerase-chain-reaction assay (RT-PCR) using materials from nasopharyngeal and oropharyngeal swabs. We performed the RT-PCR assay for A/H1N1 detection in a liver biopsy from one patient. Both patients were treated with usual doses of oseltamivir (75 mg twice daily for 5 days). One patient developed acute bacterial sinusitis requiring antibiotic therapy. Thereafter the liver enzymes increased and transplant biopsies showed moderate-to-severe acute cellular rejection. They were treated with corticosteroids. The liver enzymes normalized after 3 months.
  
  
  CONCLUSIONS
  A/H1N1 influenza can lead to a severe acute cellular rejection episode with corticosteroid resistant treatment in liver transplant patients. Transplant centers should be aware of a possible relationship between A/H1N1 infections and acute allograft rejection episodes.
authors.affiliation: Unit of Liver Transplantation, State University of Campinas, Campinas, Brazil.
authors.forename: R S B
authors.initials: RS
authors.lastname: Stucchi
authors.forename: I F S F
authors.initials: IF
authors.lastname: Boin
authors.forename: R Nogueira
authors.initials: RN
authors.lastname: Angerami
authors.forename: V
authors.initials: V
authors.lastname: Sinckoc
authors.forename: F Cesar
authors.initials: FC
authors.lastname: Sa
authors.forename: T
authors.initials: T
authors.lastname: Seva-Pereira
authors.forename: C A Fazzio
authors.initials: CA
authors.lastname: Escanhoela
mesh_terms: D000328:Adult; D006084:Graft Rejection; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000302:isolation & purification*; D007251:Influenza, Human / Q000503:physiopathology* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D012367:RNA, Viral