Members of the Novel Influenza A(H1N1) Study Group are listed in the Appendix.
Pandemic influenza A(H1N1) virus infection in solid organ transplant recipients: impact of viral and non-viral co-infection
Article first published online: 25 JUL 2011
© 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases
Clinical Microbiology and Infection
Volume 18, Issue 1, pages 67–73, January 2012
How to Cite
Cordero, E., Pérez-Romero, P., Moreno, A., Len, O., Montejo, M., Vidal, E., Martín-Dávila, P., Fariñas, M. C., Fernández-Sabé, N., Giannella, M., Pachón, J. and The Novel influenza A(H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI) (2012), Pandemic influenza A(H1N1) virus infection in solid organ transplant recipients: impact of viral and non-viral co-infection. Clinical Microbiology and Infection, 18: 67–73. doi: 10.1111/j.1469-0691.2011.03537.x
- Issue published online: 14 DEC 2011
- Article first published online: 25 JUL 2011
- Accepted manuscript online: 5 APR 2011 11:38AM EST
- Original Submission: 16 November 2010; Revised Submission: 9 March 2011; Accepted: 23 March 2011 Editor: R. Charrel Article published online: 5 April 2011
- pandemic influenza A(H1N1);
- solid organ transplant
Clin Microbiol Infect 2012; 18: 67–73
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.