Department of Infectious Diseases, Singapore General Hospital, Singapore.
Transplantation. 2010 Nov 15;90(9):1016-21. doi: 10.1097/TP.0b013e3181f546cf.
Influenza can produce significant complications in immunocompromised persons.
We studied the effects of the pandemic (H1N1) 2009 (pH1N1) infection on solid organ transplant recipients in our hospital, with emphasis on clinical information, duration of viral culture positivity, polymerase chain reaction positivity, effects of oseltamivir therapy, and graft status at 6 months of follow-up.
Twenty-two cases of pH1N1 infection involving 18 renal, two lung, one heart, and one liver transplant recipients were seen from July 14 to September 8, 2009. Their median age was 50.5 years (range 20-70 years); 64% were women, and median time posttransplant was 40 months (range 6-204 months). Common symptoms were fever (86%), cough (77%), sore throat (55%), phlegm (32%), and myalgia (27%). The median duration of symptoms (n=21) and duration of polymerase chain reaction positivity (n=15) were 7 (range 4-13 days) and 8 days (range 4-16 days), respectively. Mean (± SD) duration of symptom resolution (7.4 ± 3.0 vs. 7.8 ± 3.0 days, P=0.76) and viral culture positivity (5.3 ± 2.8 vs. 4.3 ± 3.2 days, P=0.65) did not differ between those who received a 5-day (n=9) or 10-day (n=12) course of oseltamivir. Five patients (22.7%) developed pneumonia with three needing intensive care. Mortality rate was 4.5% (1/22). At 6 months, three graft rejections involving two renal and one lung developed.
Our findings indicate that the pH1N1 infection in solid organ transplant recipients is associated with some degree of morbidity and may affect the function of the transplanted organ. In this nonrandomized comparison, patients treated with 5 days of oseltamivir did not fare worse compared with those who received 10 days.
流感可在免疫功能低下者中引起严重并发症。
我们研究了我院 2009 年大流行（H1N1）（pH1N1）感染对实体器官移植受者的影响，重点关注临床信息、病毒培养阳性持续时间、聚合酶链反应阳性、奥司他韦治疗效果以及 6 个月随访时移植物状态。
2009 年 7 月 14 日至 9 月 8 日，我们观察到 18 例肾移植、2 例肺移植、1 例心脏移植和 1 例肝移植受者发生 22 例 pH1N1 感染。其中位年龄为 50.5 岁（范围 20-70 岁）；64%为女性，移植后中位时间为 40 个月（范围 6-204 个月）。常见症状为发热（86%）、咳嗽（77%）、咽痛（55%）、咳痰（32%）和肌痛（27%）。中位症状持续时间（n=21）和聚合酶链反应阳性持续时间（n=15）分别为 7 天（范围 4-13 天）和 8 天（范围 4-16 天）。症状缓解时间（7.4 ± 3.0 天与 7.8 ± 3.0 天，P=0.76）和病毒培养阳性时间（5.3 ± 2.8 天与 4.3 ± 3.2 天，P=0.65）在接受 5 天（n=9）或 10 天（n=12）奥司他韦治疗的患者之间无差异。5 例患者（22.7%）发生肺炎，其中 3 例需要重症监护。死亡率为 4.5%（1/22）。6 个月时，3 例移植物排斥反应，其中 2 例为肾移植，1 例为肺移植。
我们的发现表明，实体器官移植受者的 pH1N1 感染与一定程度的发病率有关，并可能影响移植物的功能。在这项非随机比较中，接受 5 天奥司他韦治疗的患者与接受 10 天奥司他韦治疗的患者相比，病情并未恶化。
