Morbimortality of pandemic influenza A H1N1 infection in kidney transplant recipients requiring hospitalization: a comparative analysis with nonimmunocompromised patients.
BACKGROUND
Clinical and epidemiological data of pandemic influenza A H1N1 infection in solid-organ transplant recipients have been described, but scarce data compare these outcomes with nonimmunocompromised patients.


METHODS
We retrospectively reviewed and compared the clinical presentation, morbidity, and mortality of all kidney transplant (KT) and nonimmunocompromised (non-KT) patients admitted for at least 12 hr with a diagnosis of pandemic influenza A H1N1 infection in a single hospital complex during the 2009 pandemic.


RESULTS
There were 22 patients in the KT group (29.3%) and 53 in the non-KT group (70.7%). The prevalence of diabetes was higher in KT group (27.3% vs. 5.7%) while chronic pulmonary disease was more frequent in non-KT group (34% vs. 9.1%). Clinical and radiological presentations and duration of disease were similar between the two groups. The incidence of acute renal failure was higher among KT patients (40.9% vs. 17%). No differences in the rate of intensive care unit admission (22.7% vs. 22.6%) or hospital mortality (9.1% vs. 7.5%) were observed. For the overall population, poor outcome, defined as intensive care unit admission or death, was associated with in-hospital acquisition (relative risk [RR]=42.6 [95% confidence interval {95% CI } 2.2-831.9], P=0.003), symptom onset more than 48 hr (RR=12.17 [95% CI 1.3-117.2], P=0.007), and acute renal failure (RR=11.8 [95% CI 2.9-48.8], P<0.001). Among KT recipients, in-hospital acquisition was the only covariate associate with poor outcome (RR=30.0 [95% CI 2.1-421.1], P=0.004).


CONCLUSIONS
No significant differences in morbidity and mortality were observed comparing KT and non-KT patients infected with pandemic H1N1 influenza A virus.
Division of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Luis Fernando A
LF
Camargo
Tainá V
TV
de Sandes-Freitas
Camila D R
CD
Silva
Carolina D
CD
Bittante
Gislaine
G
Ono
Luci
L
Corrêa
Moacyr
M
Silva
Nancy Cristina J
NC
Bellei
Janaína M
JM
Goto
Eduardo A S
EA
Medeiros
Pollyane S
PS
Gomes
José O
JO
Medina-Pestana
D058186:Acute Kidney Injury / Q000453:epidemiology; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality*; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology / Q000401:mortality*; D058873:Pandemics; D015995:Prevalence; D012189:Retrospective Studies; D014180:Transplantation
D007166:Immunosuppressive Agents