Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study.
Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study.
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DOI：
10.1016/s1473-3099(10)70133-x
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发表时间：
2010-08
期刊：
影响因子：
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通讯作者：
American Society of Transplantation H1N1 Collaborative Study Group
中科院分区：
文献类型：
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作者：
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;American Society of Transplantation H1N1 Collaborative Study Group
关于实体器官移植受者流感感染的流行病学和结果的数据很少。我们的目的是在一组接受移植的患者中确定甲型H1N1大流行性流感的结局和导致严重疾病的因素。我们对2009年4月至12月接受器官移植且微生物学证实感染甲型流感的成人和儿童进行了一项多中心队列研究。中心是通过美国移植学会流感合作研究组确定的。评估了人口统计学、临床表现、治疗和结果。疾病的严重程度通过住院和重症监护病房（icu）来衡量。资料用描述性统计进行分析。比例比较采用χ2检验。我们使用单变量分析来确定导致肺炎、住院和ICU住院的因素。采用逐步logistic回归模型进行多因素分析。我们用Kaplan-Meier生存分析分析死亡病例。我们评估了在研究期间来自26个移植中心的237例经医疗护理的甲型H1N1流感病例。移植类型包括肾、肝、心、肺和其他器官。对成人（154例，中位年龄47岁）和儿童（83例，9岁）进行了评估。移植后的中位时间为3.6年。237例患者中有167例（71%）住院。230例患者可获得并发症数据；73例（32%）发生肺炎，37例（16%）入住icu， 10例（4%）死亡。223例（94%）患者接受抗病毒治疗（主要是奥司他韦单药治疗）。7例（8%）患者在症状出现48小时内接受抗病毒药物治疗，28例（22.4%）患者在症状出现48小时后接受抗病毒药物治疗（p=0.007）。接受移植的儿童患肺炎的可能性低于成人，但住院率和ICU住院率相似。甲型H1N1流感在2009-10年大流行期间导致实体器官移植受者大量发病。通过ICU住院和机械通气的需要来衡量，早期开始抗病毒治疗与临床获益相关。
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. 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. 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. 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.