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

Abstract

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.

Randomized Controlled Trial of High-Dose Intradermal Versus Standard-Dose Intramuscular Influenza Vaccine in Organ Transplant Recipients

“…Analysis excludes seven patients on Myfortic. 4 Excludes patients on cyclosporine instead of tacrolimus. ATG = antithymocyte globulin; MMF = mycophenolate mofetil.…”

“…In addition to increased rates of lower respiratory infection with influenza, studies have also reported increased acute and chronic allograft rejection after infection, specifically in lung and kidney transplant recipients (1,(3)(4)(5). Therefore, SOT patients are recommended to receive the annual trivalent inactivated influenza vaccine (6,7).…”

Update on viral infections in lung transplantation

“…A more recent study from the US showed that lung transplantation recipients were not affected more than other solid organ recipients concerning H1N1 infection [32 & ]; a single-center study in Israel reported 5% H1N1 confirmed cases in the lung transplantation recipient cohorts without any reports of death [33]. The incidence in Australia was 3% among recipients with BOS progression after initial recovery [34]. A different scenario may arise if H1N1 infection coincides with the lung transplantation.…”

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation

“…In particular, influenza in SOT recipients is associated with a higher rate of bacterial pneumonia, hospitalization, need for invasive ventilation and even death (125). Importantly, during the 2009 influenza A H1N1 pandemic, a significant number of cases of acute allograft injury due to influenza were observed (126)(127)(128). Severe cases of other CARVs, such as respiratory syncytial virus (RSV), parainfluenza virus and human metapneumovirus, have been described (129)(130)(131).…”