After the Influenza A H1N1 pandemic infection of 2009 there was increased concern regarding worse clinical presentations in transplant recipients. We compared outcomes of influenza A and B infection in hematopoietic stem cell transplant (HSCT) and lung transplant (LT) recipients with non transplant patients.
All polymerase chain reaction (PCR) proven influenza A and B cases in adults diagnosed from December 2008 to May 2012 were identified. HSCT and LT recipients were compared to non-transplant patients matched on period of influenza diagnosis, age, gender and race.
Primary enpoints were need for Emergency Department (ED) visit, hospitalization for influenza related complications and 30-day mortality from the influenza diagnosis. Secondary endpoints were correlation of immunosuppressants and comorbidities with the primary outcomes.
Chi-square tests, variance inflation factor, condition indices and Cox proportional hazards model were used for analyses.
2273 positive results of influenza PCR test were found in 2220 unique patients. Of these, 26 were HSCT recipients and 24 were LT recipients. 50 matching controls were assigned.
By multivariate analysis, HSCT recipients had more ED visits (OR: 25.55, P<0.0001) and hospitalizations for influenza (OR: 23.18, P<0.001). No significant differences were found in LT recipients. 3 HSCT and 1 LT recipient died within 30 days from the influenza diagnosis.
By univariate analysis, HSCT recipients with diabetes mellitus (DM) had more influenza related ED visits (OR: 4.02, P=0.043) and hospitalizations (OR: 15.5, P=0.018) than controls. Graft versus host disease (GVHD) was also associated with more ED visits (OR: 8.1, P=0.02) and hospitalizations (OR: 27.06, P=0.024). Only DM remained significant after a reduced multivariable analysis was applied. For LT recipients, no variables were significant.
21 transplant recipients (42%) and 8 (16%) of the controls had documented antecedent influenza vaccination for the same season (P=0.0076).
Transplant recipients underwent more respiratory tract imaging than the controls: 46 (92%) vs. 31 (62%) (P=0.0006).
No episodes of graft rejection occurred within 30 days of influenza infection.
Conclusions: HSCT recipients had increased incidence of ED visits and hospitalization for influenza. Similar findings were not found in LT recipients. There was no statistically significant difference in the 30-day mortality in both groups.
To cite this abstract in AMA style:Morais AGuedesde, Duin Dvan, Shrestha N, Mossad S. Outcomes of Influenza Infection in Adult Hematopoietic Stem Cell Transplant and Lung Transplant Recipients Compared to Non Transplant Patients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/outcomes-of-influenza-infection-in-adult-hematopoietic-stem-cell-transplant-and-lung-transplant-recipients-compared-to-non-transplant-patients/. Accessed December 6, 2023.
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