title: Pandemic influenza A(H1N1) virus infection in solid organ transplant recipients: impact of viral and non-viral co-infection.
abstract: Solid organ transplant recipients (SOTR) are at risk of serious influenza-related complications. The impact of respiratory co-infection in SOTR with 2009 pandemic influenza A(H1N1) is unknown. A multicentre prospective study of consecutive cases of pandemic influenza A(H1N1) in SOTR was carried out to assess the clinical characteristics and outcome and the risk factors for co-infection. Overall, 51 patients were included. Median time from transplant was 3.7 years, 5.9% of the cases occurred perioperatively and 7.8% were hospital-acquired. Pneumonia was diagnosed in 15 (29.4%) patients. Ten cases were severe (19.6%): 13.7% were admitted to intensive care units, 5.9% suffered septic shock, 5.9% developed acute graft rejection and 7.8% died. Co-infection was detected in 15 patients (29.4%): eight viral, six bacterial and one fungal. Viral co-infection did not affect the outcome. Patients with non-viral co-infection had a worse outcome: longer hospital stay (26.2 ± 20.7 vs. 5.5 ± 10.2) and higher rate of severe diseases (85.7% vs. 2.3%) and mortality (42.8% vs. 2.3%). Independent risk factors for non-viral co-infection were: diabetes mellitus and septic shock. Other factors associated with severe influenza were: delayed antiviral therapy, diabetes mellitus, time since transplantation <90 days and pneumonia. In conclusion, pandemic influenza A can cause significant direct and indirect effects in SOTR, especially in the early post-transplant period, and should be treated early. Clinicians should be aware of the possibility of non-viral co-infection, mainly in diabetic patients and severe cases. An effort should be made to prevent influenza with immunization of the patient and the environment.
authors.affiliation: Infectious Diseases Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina Sevilla, Sevilla, Spain. mariae.cordero.sspa@juntadeandalucia.es
authors.forename: E
authors.initials: E
authors.lastname: Cordero
authors.forename: P
authors.initials: P
authors.lastname: Pérez-Romero
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.forename: O
authors.initials: O
authors.lastname: Len
authors.forename: M
authors.initials: M
authors.lastname: Montejo
authors.forename: E
authors.initials: E
authors.lastname: Vidal
authors.forename: P
authors.initials: P
authors.lastname: Martín-Dávila
authors.forename: M C
authors.initials: MC
authors.lastname: Fariñas
authors.forename: N
authors.initials: N
authors.lastname: Fernández-Sabé
authors.forename: M
authors.initials: M
authors.lastname: Giannella
authors.forename: J
authors.initials: J
authors.lastname: Pachón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D060085:Coinfection; D003428:Cross Infection; D048909:Diabetes Complications; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity*; D007251:Influenza, Human / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects / Q000401:mortality*; D011014:Pneumonia / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult