*Purpose: Influenza is commonly considered a community acquired infection, but in transplant recipients, nosocomial transmission is frequently encountered. The lung transplant program at Temple University Hospital implemented influenza prophylaxis with oseltamivir in all hospitalized lung transplant recipients (LTR) to help prevent nosocomial transmission. The aim of this study was to evaluate influenza rates pre- and post-implementation of oseltamivir prophylaxis in LTR.

*Methods: In this retrospective, single-center, cohort study, all patients who received a single, double, or dual heart-lung transplant were included with the pre-oseltamivir prophylaxis group’s transplants occurring between 8/6/16-2/14/18. The post-exposure prophylaxis group included patients transplanted between 2/15/18-4/30/20 who were within one year of transplant date, had not received an influenza vaccination for that respective season or were being treated for rejection. Patients were excluded if they were positive for influenza within 48 hours of hospital admission or had donor-derived influenza. The primary and secondary objectives were incidence rates of influenza in both groups, as well as compliance, adverse events, and costs for the post-exposure prophylaxis group.

*Results: A total of 463 LTR were screened, and 399 patients were included with a mean follow-up time of 12 months (pre-oseltamivir group [n=158]; post-oseltamivir group [n=241]). Majority of patients were caucasians (77% vs. 78%; p=0.89). The influenza vaccination rate was 46.2% and 67.6% in the pre- and post-groups (p<0.0001), respectively. The use of basiliximab induction was very similar (56% vs. 59%; p=0.58). The influenza infection rate within the first-year post lung transplant was statistically significantly higher in the pre-group compared to the post-group (3.2% vs. 0%; p<0.01). The oseltamivir protocol compliance rates during the 2017-2018, 2018-2019, 2019-2020 seasons were 87.5%, 95.5% and 96.3%, respectively. No oseltamivir adverse events were reported. The medical costs associated in treating positive influenza cases in the pre-group ($49,713.36) was significantly higher than the cost of drug required for the oseltamivir prophylaxis protocol ($14,977.26), with a potential cost savings of $34,736.10.

*Conclusions: Among LTR receiving the prophylaxis protocol, the influenza rate was statistically significantly lower in preventing nosocomial transmission; however, the higher vaccination rate in the post-group may be inflating the efficacy of the prophylaxis protocol. The use of the protocol is favored to avoid costs related to influenza-associated hospitalizations at no increased risk of adverse events.

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