Date: Monday, May 1, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 2:42pm-2:54pm
Influenza infection significantly impacts transplant patients. Despite this, there are limited data on how virological characteristics, including influenza viral load (VL), impact the outcome of infection.
Transplant recipients with lab-confirmed influenza A infection were enrolled in a prospective multicenter cohort clinical study from 2010-15. Nasopharyngeal swabs were taken at diagnosis (day 0) and days 3, 6, 11, 18 and 28. Influenza VL (lower limit of detection (LOD) 102 copies/mL) was measured by real-time RT-PCR.
Serial swabs were available from 258 patients. Median age was 56 years (range 2-83). Transplant types were kidney (38%), lung (19%), liver (17%), heart (12%), and hematopoietic stem cell (HSCT) (14%). Pneumonia occurred in 21.9% of patients and 10.8% of all patients were admitted to the ICU. The majority (94.2%) of patients were treated with oseltamivir and death occurred in 5.4% of patients. The proportion of transplant recipients with a positive NP swab on days 0, 3, 6, 11, 18 and 28 was 87%, 76%, 45%, 25%, 7.1% and 0%, respectively. At days 0 and 3, median VLs were 1.3×104 and 9.1×102, respectively. From day 6 to 28, the median VLs were below the LOD. HSCT recipients had significantly higher median VLs than SOT recipients at day 0 (1.0×105 vs. 8.4×103; p=0.001), day 3 (3.2×103 vs. 7.9×102; p=0.015) and day 6 (7.0×102 vs.<LOD; p=0.003). Transplant recipients who did not receive influenza vaccine within the same season as infection had a 7.6-fold higher median VL at day 0, compared to vaccinated (5.6×104 vs. 7.4×103; p=0.026). Those with pneumonia had significantly higher median VLs at days 0, 3, 6 and 11 (p<0.001). Interestingly, the day 0 VL for recipients who developed pneumonia was 39-fold higher than those that did not (2.9×105 vs. 7.4×103). Median VLs were higher at days 0 (p=0.0084), 3 (p=0.0049), 6 (p=0.021) and 11 (p=0.0049) among those admitted to the ICU.
We provide unique insight into viral dynamics in transplant patients. Our study shows high influenza viral loads are associated with severity of illness and absence of previous vaccination.
CITATION INFORMATION: Ferreira V, Humar A, Cordero E, Blumberg E, Limaye A, Silveira F, Danziger-Isakov L, Levi M, Kalpoe J, Englund J, Multicenter Influenza Group M, Kumar D. Influenza Viral Dynamics in a Large Cohort of Transplant Patients with Natural Influenza Infection. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Ferreira V, Humar A, Cordero E, Blumberg E, Limaye A, Silveira F, Danziger-Isakov L, Levi M, Kalpoe J, Englund J, Group MMulticenterInfluenza, Kumar D. Influenza Viral Dynamics in a Large Cohort of Transplant Patients with Natural Influenza Infection. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/influenza-viral-dynamics-in-a-large-cohort-of-transplant-patients-with-natural-influenza-infection/. Accessed November 23, 2020.
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