Original Articles
The Impact of Pandemic Influenza A H1N1 2009 on Australian Lung Transplant Recipients

https://doi.org/10.1111/j.1600-6143.2010.03422.xGet rights and content
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Influenza A H1N1 2009 led to 189 deaths during the Australian pandemic. Community-acquired respiratory viruses not only can cause prolonged allograft dysfunction in lung transplant recipients but have also been linked to bronchiolitis obliterans syndrome (BOS). We report the impact of the 2009 H1N1 pandemic on Australian lung transplant recipients. An observational study of confirmed H1N1 cases was conducted across five Australian lung transplant programs during the pandemic. An electronic database collected patient demographics, clinical presentation, management and outcomes up to a year follow-up. Twenty-four H1N1 cases (mean age 43 ± 14 years, eight females) were identified, incidence of 3%. Illness severity varied from upper respiratory tract symptoms only in 29% to lung allograft dysfunction (≥10% decline FEV1) in 75% to death in 5 (21%) cases (pre-existing BOS grade 3, n = 4). Treatment with oseltamivir occurred in all but one case confirmed after death, reduced immunosuppression, n = 1, augmented corticosteroid therapy, n = 16, and mechanical/noninvasive ventilation, n = 4. There was BOS grade decline within a year in six cases (32%). In conclusion, Australian lung transplant recipients were variably affected by the H1N1 pandemic mirroring the broader community with significant morbidity and mortality. After initial recovery, a considerable proportion of survivors have demonstrated BOS progression.

Key words:

Bronchiolitis obliterans syndrome
H1N1 subtype
influenza A
lung transplantation
outcomes
pandemic influenza

Abbreviations:

CARV
community-acquired respiratory virus
FEV1
forced expiratory volume in 1 second
BOS
bronchiolitis obliterans syndrome
ICU
intensive care unit
ECMO
extracorporeal membrane oxygenation
ISHLT
International Society of Heart and Lung Transplantation
NPS
nasopharyngeal swab
PCR
polymerase chain reaction
RT-PCR
reverse transcriptase—polymerase chain reaction
URTI
upper respiratory tract infection
MRSA
methicillin-resistant staphylococcus aureus
ARDS
acute respiratory distress syndrome

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