Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: A multicentre cohort study

Deepali Kumar, Marian G. Michaels, Michele I Morris, Michael Green, Robin K. Avery, Catherine Liu, Lara Danziger-Isakov, Valentina Stosor, Michele Estabrook, Soren Gantt, Kieren A. Marr, Stanley Martin, Fernanda P. Silveira, Raymund R. Razonable, Upton D. Allen, Marilyn E. Levi, G. Marshall Lyon, Lorraine E. Bell, Shirish Huprikar, Gopi PatelKevin S. Gregg, Kenneth Pursell, Doug Helmersen, Kathleen G. Julian, Kevin Shiley, Bartholomew Bono, Vikas R. Dharnidharka, Gelareh Alavi, Jayant S. Kalpoe, Shmuel Shoham, Gail E. Reid, Atul Humar

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Abstract

Background: There are few data on the epidemiology and outcomes of influenza infection in recipients of solid-organ transplants. We aimed to establish the outcomes of pandemic influenza A H1N1 and factors leading to severe disease in a cohort of patients who had received transplants. Methods: We did a multicentre cohort study of adults and children who had received organ transplants with microbiological confirmation of influenza A infection from April to December, 2009. Centres were identified through the American Society of Transplantation Influenza Collaborative Study Group. Demographics, clinical presentation, treatment, and outcomes were assessed. Severity of disease was measured by admission to hospital and intensive care units (ICUs). The data were analysed with descriptive statistics. Proportions were compared by use of χ2 tests. We used univariate analysis to identify factors leading to pneumonia, admission to hospital, and admission to an ICU. Multivariate analysis was done by use of a stepwise logistic regression model. We analysed deaths with Kaplan-Meier survival analysis. Findings: We assessed 237 cases of medically attended influenza A H1N1 reported from 26 transplant centres during the study period. Transplant types included kidney, liver, heart, lung, and others. Both adults (154 patients; median age 47 years) and children (83; 9 years) were assessed. Median time from transplant was 3·6 years. 167 (71%) of 237 patients were admitted to hospital. Data on complications were available for 230 patients; 73 (32%) had pneumonia, 37 (16%) were admitted to ICUs, and ten (4%) died. Antiviral treatment was used in 223 (94%) patients (primarily oseltamivir monotherapy). Seven (8%) patients given antiviral drugs within 48 h of symptom onset were admitted to an ICU compared with 28 (22·4%) given antivirals later (p=0·007). Children who received transplants were less likely to present with pneumonia than adults, but rates of admission to hospital and ICU were similar. Interpretation: Influenza A H1N1 caused substantial morbidity in recipients of solid-organ transplants during the 2009-10 pandemic. Starting antiviral therapy early is associated with clinical benefit as measured by need for ICU admission and mechanical ventilation. Funding: None.

Original languageEnglish
Pages (from-to)521-526
Number of pages6
JournalThe Lancet Infectious Diseases
Volume10
Issue number8
DOIs
StatePublished - Aug 1 2010

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Pandemics
Human Influenza
Multicenter Studies
Cohort Studies
Transplants
Intensive Care Units
Infection
Antiviral Agents
Pneumonia
Logistic Models
Oseltamivir
Kaplan-Meier Estimate
Survival Analysis
Artificial Respiration
Epidemiology
Multivariate Analysis
Demography
Morbidity
Kidney
Lung

ASJC Scopus subject areas

  • Infectious Diseases

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Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants : A multicentre cohort study. / Kumar, Deepali; Michaels, Marian G.; Morris, Michele I; Green, Michael; Avery, Robin K.; Liu, Catherine; Danziger-Isakov, Lara; Stosor, Valentina; Estabrook, Michele; Gantt, Soren; Marr, Kieren A.; Martin, Stanley; Silveira, Fernanda P.; Razonable, Raymund R.; Allen, Upton D.; Levi, Marilyn E.; Lyon, G. Marshall; Bell, Lorraine E.; Huprikar, Shirish; Patel, Gopi; Gregg, Kevin S.; Pursell, Kenneth; Helmersen, Doug; Julian, Kathleen G.; Shiley, Kevin; Bono, Bartholomew; Dharnidharka, Vikas R.; Alavi, Gelareh; Kalpoe, Jayant S.; Shoham, Shmuel; Reid, Gail E.; Humar, Atul.

In: The Lancet Infectious Diseases, Vol. 10, No. 8, 01.08.2010, p. 521-526.

Research output: Contribution to journalArticle

Kumar, D, Michaels, MG, Morris, MI, Green, M, Avery, RK, Liu, C, Danziger-Isakov, L, Stosor, V, Estabrook, M, Gantt, S, Marr, KA, Martin, S, Silveira, FP, Razonable, RR, Allen, UD, Levi, ME, Lyon, GM, Bell, LE, Huprikar, S, Patel, G, Gregg, KS, Pursell, K, Helmersen, D, Julian, KG, Shiley, K, Bono, B, Dharnidharka, VR, Alavi, G, Kalpoe, JS, Shoham, S, Reid, GE & Humar, A 2010, 'Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: A multicentre cohort study', The Lancet Infectious Diseases, vol. 10, no. 8, pp. 521-526. https://doi.org/10.1016/S1473-3099(10)70133-X
Kumar, Deepali ; Michaels, Marian G. ; Morris, Michele I ; Green, Michael ; Avery, Robin K. ; Liu, Catherine ; Danziger-Isakov, Lara ; Stosor, Valentina ; Estabrook, Michele ; Gantt, Soren ; Marr, Kieren A. ; Martin, Stanley ; Silveira, Fernanda P. ; Razonable, Raymund R. ; Allen, Upton D. ; Levi, Marilyn E. ; Lyon, G. Marshall ; Bell, Lorraine E. ; Huprikar, Shirish ; Patel, Gopi ; Gregg, Kevin S. ; Pursell, Kenneth ; Helmersen, Doug ; Julian, Kathleen G. ; Shiley, Kevin ; Bono, Bartholomew ; Dharnidharka, Vikas R. ; Alavi, Gelareh ; Kalpoe, Jayant S. ; Shoham, Shmuel ; Reid, Gail E. ; Humar, Atul. / Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants : A multicentre cohort study. In: The Lancet Infectious Diseases. 2010 ; Vol. 10, No. 8. pp. 521-526.
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author = "Deepali Kumar and Michaels, {Marian G.} and Morris, {Michele I} and Michael Green and Avery, {Robin K.} and Catherine Liu and Lara Danziger-Isakov and Valentina Stosor and Michele Estabrook and Soren Gantt and Marr, {Kieren A.} and Stanley Martin and Silveira, {Fernanda P.} and Razonable, {Raymund R.} and Allen, {Upton D.} and Levi, {Marilyn E.} and Lyon, {G. Marshall} and Bell, {Lorraine E.} and Shirish Huprikar and Gopi Patel and Gregg, {Kevin S.} and Kenneth Pursell and Doug Helmersen and Julian, {Kathleen G.} and Kevin Shiley and Bartholomew Bono and Dharnidharka, {Vikas R.} and Gelareh Alavi and Kalpoe, {Jayant S.} and Shmuel Shoham and Reid, {Gail E.} and Atul Humar",
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T1 - Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants

T2 - A multicentre cohort study

AU - Kumar, Deepali

AU - Michaels, Marian G.

AU - Morris, Michele I

AU - Green, Michael

AU - Avery, Robin K.

AU - Liu, Catherine

AU - Danziger-Isakov, Lara

AU - Stosor, Valentina

AU - Estabrook, Michele

AU - Gantt, Soren

AU - Marr, Kieren A.

AU - Martin, Stanley

AU - Silveira, Fernanda P.

AU - Razonable, Raymund R.

AU - Allen, Upton D.

AU - Levi, Marilyn E.

AU - Lyon, G. Marshall

AU - Bell, Lorraine E.

AU - Huprikar, Shirish

AU - Patel, Gopi

AU - Gregg, Kevin S.

AU - Pursell, Kenneth

AU - Helmersen, Doug

AU - Julian, Kathleen G.

AU - Shiley, Kevin

AU - Bono, Bartholomew

AU - Dharnidharka, Vikas R.

AU - Alavi, Gelareh

AU - Kalpoe, Jayant S.

AU - Shoham, Shmuel

AU - Reid, Gail E.

AU - Humar, Atul

PY - 2010/8/1

Y1 - 2010/8/1

N2 - Background: There are few data on the epidemiology and outcomes of influenza infection in recipients of solid-organ transplants. We aimed to establish the outcomes of pandemic influenza A H1N1 and factors leading to severe disease in a cohort of patients who had received transplants. Methods: We did a multicentre cohort study of adults and children who had received organ transplants with microbiological confirmation of influenza A infection from April to December, 2009. Centres were identified through the American Society of Transplantation Influenza Collaborative Study Group. Demographics, clinical presentation, treatment, and outcomes were assessed. Severity of disease was measured by admission to hospital and intensive care units (ICUs). The data were analysed with descriptive statistics. Proportions were compared by use of χ2 tests. We used univariate analysis to identify factors leading to pneumonia, admission to hospital, and admission to an ICU. Multivariate analysis was done by use of a stepwise logistic regression model. We analysed deaths with Kaplan-Meier survival analysis. Findings: We assessed 237 cases of medically attended influenza A H1N1 reported from 26 transplant centres during the study period. Transplant types included kidney, liver, heart, lung, and others. Both adults (154 patients; median age 47 years) and children (83; 9 years) were assessed. Median time from transplant was 3·6 years. 167 (71%) of 237 patients were admitted to hospital. Data on complications were available for 230 patients; 73 (32%) had pneumonia, 37 (16%) were admitted to ICUs, and ten (4%) died. Antiviral treatment was used in 223 (94%) patients (primarily oseltamivir monotherapy). Seven (8%) patients given antiviral drugs within 48 h of symptom onset were admitted to an ICU compared with 28 (22·4%) given antivirals later (p=0·007). Children who received transplants were less likely to present with pneumonia than adults, but rates of admission to hospital and ICU were similar. Interpretation: Influenza A H1N1 caused substantial morbidity in recipients of solid-organ transplants during the 2009-10 pandemic. Starting antiviral therapy early is associated with clinical benefit as measured by need for ICU admission and mechanical ventilation. Funding: None.

AB - Background: There are few data on the epidemiology and outcomes of influenza infection in recipients of solid-organ transplants. We aimed to establish the outcomes of pandemic influenza A H1N1 and factors leading to severe disease in a cohort of patients who had received transplants. Methods: We did a multicentre cohort study of adults and children who had received organ transplants with microbiological confirmation of influenza A infection from April to December, 2009. Centres were identified through the American Society of Transplantation Influenza Collaborative Study Group. Demographics, clinical presentation, treatment, and outcomes were assessed. Severity of disease was measured by admission to hospital and intensive care units (ICUs). The data were analysed with descriptive statistics. Proportions were compared by use of χ2 tests. We used univariate analysis to identify factors leading to pneumonia, admission to hospital, and admission to an ICU. Multivariate analysis was done by use of a stepwise logistic regression model. We analysed deaths with Kaplan-Meier survival analysis. Findings: We assessed 237 cases of medically attended influenza A H1N1 reported from 26 transplant centres during the study period. Transplant types included kidney, liver, heart, lung, and others. Both adults (154 patients; median age 47 years) and children (83; 9 years) were assessed. Median time from transplant was 3·6 years. 167 (71%) of 237 patients were admitted to hospital. Data on complications were available for 230 patients; 73 (32%) had pneumonia, 37 (16%) were admitted to ICUs, and ten (4%) died. Antiviral treatment was used in 223 (94%) patients (primarily oseltamivir monotherapy). Seven (8%) patients given antiviral drugs within 48 h of symptom onset were admitted to an ICU compared with 28 (22·4%) given antivirals later (p=0·007). Children who received transplants were less likely to present with pneumonia than adults, but rates of admission to hospital and ICU were similar. Interpretation: Influenza A H1N1 caused substantial morbidity in recipients of solid-organ transplants during the 2009-10 pandemic. Starting antiviral therapy early is associated with clinical benefit as measured by need for ICU admission and mechanical ventilation. Funding: None.

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