Transplantation of solid organs procured from influenza A H1N1 infected donors

Abstract

Summary Following the influenza A H1N1 (swine flu) pandemic, there remains little evidence informing the safety of transplanting organs from donors suspected or diagnosed with H1N1. Limited guidelines from the major transplant societies leave the use of such organs at the discretion of individual transplant centres, and practice varies considerably both nationally and internationally. We present the largest published series of outcome following transplantation of organs from H1N1 positive donors and demonstrate that these organs can be transplanted safely and with good short‐term outcome. We discuss our local policy for treatment of recipients with Oseltamivir.

Pediatric heart transplantation from an influenza B–positive donor

“…Donor‐derived infections may be associated with substantial morbidity and even mortality in transplant recipients . Though disease transmission has been well documented in solid organ transplant recipients from a variety of bacteria, fungi, and viruses, the overall incidence of clinically significant transmission has been estimated at 0.2% and is likely lower for hearts as compared to the transplantation of lymphoid dense organs such as lung and intestines . The key to success may be in risk stratification and successful treatment and management of the infectious processes.…”

“…There is no consensus regarding the duration of antiviral therapy, specific drug choice, or the utility in using a more liberal immunosuppressive regimen in the immediate post‐transplant period for solid organ transplant recipients of organs from influenza‐infected donors . In general however, the majority of successful solid organ transplants from influenza‐infected donors have followed several days of oseltamivir therapy for both the donor and recipient seemingly without any marked change in post‐transplant immunosuppression regimen, all without disease transmission.…”

“…A number of centers have demonstrated excellent short-term outcomes in solid organ transplantation from influenza-positive donors, particularly following the 2009 H1N1 influenza pandemic. 11,12,20,21 For example, of 13 solid organ transplant recipients from H1N1 influenza-infected donors in the United Kingdom, Halliday and colleagues demonstrated no cases of virus transmission despite the fact that three donors did not receive antiviral therapy and only seven of the recipients received prophylaxis. 12 While encouraging, most guidelines would still recommend recipients of any organs from donors infected with influenza receive 10 days of antiviral post-exposure prophylaxis, administered at full therapeutic doses.…”

“…20 There is no consensus regarding the duration of antiviral therapy, specific drug choice, or the utility in using a more liberal immunosuppressive regimen in the immediate post-transplant period for solid organ transplant recipients of organs from influenza-infected donors. 10,11,20,21 In general however, the majority of successful solid organ transplants from influenza-infected donors have followed several days of oseltamivir therapy for both the donor and recipient seemingly without any marked change in post-transplant immunosuppression regimen, all without disease transmission. Based on these reports and to the best of our knowledge, our first report in a pediatric heart transplant patient, now with 6 months of follow-up without infection or rejection, we will continue to accept otherwise suitable hearts from influenza-infected donors even for high-risk patients.…”

Influenza prevention and treatment in transplant recipients and immunocompromised hosts

“…[86][87][88][89] Transmission has not been documented in other transplant recipients. 86 The patterns of influenza replication, particularly with novel or avian strains, should be considered in determining the potential risk of transmission in non-lung recipients. 9 If influenza is transmitted through organ donation, viremia and atypical presentations, with limited to no respiratory symptoms, may occur initially in extra-pulmonary transplant recipients.…”