实体器官移植受者感染甲型 H1N1 流感的结局：一项多中心队列研究。
Outcomes from pandemic influenza A H1N1 infection in recipients of solid-organ transplants: a multicentre cohort study.
机构信息
University of Alberta, Edmonton, AB, Canada.
出版信息
Lancet Infect Dis. 2010 Aug;10(8):521-6. doi: 10.1016/S1473-3099(10)70133-X. Epub 2010 Jul 9.
BACKGROUND
There are few data on the epidemiology and outcomes of influenza infection in recipients of solid-organ transplants. We aimed to establish the outcomes of pandemic influenza A H1N1 and factors leading to severe disease in a cohort of patients who had received transplants.
METHODS
We did a multicentre cohort study of adults and children who had received organ transplants with microbiological confirmation of influenza A infection from April to December, 2009. Centres were identified through the American Society of Transplantation Influenza Collaborative Study Group. Demographics, clinical presentation, treatment, and outcomes were assessed. Severity of disease was measured by admission to hospital and intensive care units (ICUs). The data were analysed with descriptive statistics. Proportions were compared by use of chi(2) tests. We used univariate analysis to identify factors leading to pneumonia, admission to hospital, and admission to an ICU. Multivariate analysis was done by use of a stepwise logistic regression model. We analysed deaths with Kaplan-Meier survival analysis.
FINDINGS
We assessed 237 cases of medically attended influenza A H1N1 reported from 26 transplant centres during the study period. Transplant types included kidney, liver, heart, lung, and others. Both adults (154 patients; median age 47 years) and children (83; 9 years) were assessed. Median time from transplant was 3.6 years. 167 (71%) of 237 patients were admitted to hospital. Data on complications were available for 230 patients; 73 (32%) had pneumonia, 37 (16%) were admitted to ICUs, and ten (4%) died. Antiviral treatment was used in 223 (94%) patients (primarily oseltamivir monotherapy). Seven (8%) patients given antiviral drugs within 48 h of symptom onset were admitted to an ICU compared with 28 (22.4%) given antivirals later (p=0.007). Children who received transplants were less likely to present with pneumonia than adults, but rates of admission to hospital and ICU were similar.
INTERPRETATION
Influenza A H1N1 caused substantial morbidity in recipients of solid-organ transplants during the 2009-10 pandemic. Starting antiviral therapy early is associated with clinical benefit as measured by need for ICU admission and mechanical ventilation.
FUNDING
None.
背景
关于实体器官移植受者流感感染的流行病学和结果，数据很少。我们旨在确定大流行流感 A H1N1 对接受过移植的患者的影响，并确定导致严重疾病的因素。
方法
我们对 2009 年 4 月至 12 月期间，通过微生物学确认患有甲型流感 A 感染的接受器官移植的成年人和儿童进行了多中心队列研究。中心是通过美国移植协会流感协作研究小组确定的。评估了人口统计学，临床表现，治疗和结局。通过住院和重症监护病房（ICU）入院来衡量疾病的严重程度。数据采用描述性统计进行分析。通过使用卡方检验比较比例。我们使用单变量分析来确定导致肺炎，住院和入住 ICU 的因素。使用逐步逻辑回归模型进行多变量分析。我们使用 Kaplan-Meier 生存分析来分析死亡。
结果
我们评估了研究期间从 26 个移植中心报告的 237 例经医学治疗的甲型 H1N1 流感病例。移植类型包括肾脏，肝脏，心脏，肺和其他器官。评估了成年人（154 例；中位年龄 47 岁）和儿童（83 例；9 岁）。从移植到中位数的时间为 3.6 年。237 例患者中有 167 例（71％）住院。可获得 230 例患者的并发症数据；73 例（32％）患有肺炎，37 例（16％）入住 ICU，10 例（4％）死亡。223 例（94％）患者使用了抗病毒药物（主要是奥司他韦单药治疗）。在症状出现后 48 小时内接受抗病毒药物治疗的 7 例（8％）患者需要入住 ICU，而较晚（症状出现后 48 小时后）接受抗病毒药物治疗的 28 例（22.4％）患者需要入住 ICU（p=0.007）。接受移植的儿童比成年人更不可能出现肺炎，但住院和 ICU 入院率相似。
解释
甲型 H1N1 在 2009-10 年大流行期间给实体器官移植受者造成了严重的发病率。尽早开始抗病毒治疗与 ICU 入院和机械通气需求所衡量的临床益处相关。
资金
无。
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