Original clinical science
Pandemic influenza (H1N1): Impact on lung transplant recipients and candidates

https://doi.org/10.1016/j.healun.2010.05.007Get rights and content

Background

The year 2009 was notable for the outbreak of a novel strain of influenza A (H1N1). We report the outcomes of H1N1 infection in a large cohort of lung transplant (LTx) recipients and candidates.

Methods

This was a retrospective review of 22 suspected cases of H1N1 influenza screened using real-time polymerase chain reaction from nasal secretions. There were 15 confirmed cases (10 LTx recipients, 5 LTx candidates).

Results

All patients were treated with oseltamivir at the time of the first clinical assessment. In the LTx recipients group, 7 of the 10 confirmed cases were treated at home with oseltamivir alone. Three patients were admitted with complications (2 pneumonia, 1 acute rejection). Two patients required mechanical ventilation. Two patients had prolonged viral shedding. No deaths occurred among the LTx recipients. In the 5 LTx candidates with confirmed H1N1, 2 deaths occurred from pneumonia and acute respiratory distress syndrome.

Conclusions

Influenza H1N1 had a significant complication rate amongst LTx recipients and a high mortality rate amongst LTx candidates.

Section snippets

Rabin Medical Center Lung Transplantation Program

Rabin Medical Center (RMC) is a major tertiary medical facility in central Israel and is the only national center offering LTx. Since its inception, RMC has performed more than 314 LTx, and in recent years has performed between 40 and 50 LTx annually.

All LTx recipients were advised to obtain seasonal and H1N1 influenza vaccinations from their family doctor. Furthermore, we emphasized to the LTx recipient cohort the importance of urgent attendance for medical care in the case of influenza

General information

At the official start of the H1N1 pandemic, 190 allograft recipients were alive. There were 19 transplant procedures during the study period. There was 1 peri-transplant death, and 9 existing allograft recipients died of non-H1N1 causes. H1N1 evaluations in 17 LTx recipients during the study period confirmed 10 cases (5% of cohort at start of the pandemic). Amongst the 60 LTx candidates on the waiting list, 5 confirmed cases were identified (8% at start of the pandemic). Confirmed cases of H1N1

Discussion

We present a single-center experience of the effect of H1N1 pandemic influenza on patients before and after LTx. We monitored 10 LTx recipients and 5 LTx candidates who presented to our center with confirmed H1N1 and observed a significant incidence of complications. No deaths occurred amongst the LTx recipients, although 2 patients required mechanical ventilation and 2 patients had prolonged illness with shedding of H1N1 in nasal secretions.

This is the first case series that we are aware of

Disclosure statement

None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

References (12)

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