Division of Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Transplantation. 2021 May 1;105(5):968-978. doi: 10.1097/TP.0000000000003486.
Influenza infection poses significant risk for solid organ transplant recipients who often experience more severe infection with increased rates of complications, including those relating to the allograft. Although symptoms of influenza experienced by transplant recipients are similar to that of the general population, fever is not a ubiquitous symptom and lymphopenia is common. Annual inactivated influenza vaccine is recommended for all transplant recipients. Newer strategies such as using a higher dose vaccine or multiple doses in the same season appear to provide greater immunogenicity. Neuraminidase inhibitors are the mainstay of treatment and chemoprophylaxis although resistance may occur in the transplant setting. Influenza therapeutics are advancing, including the recent licensure of baloxavir; however, many remain to be evaluated in transplant recipients and are not yet in routine clinical use. Further population-based studies spanning multiple influenza seasons are needed to enhance our understanding of influenza epidemiology in solid organ transplant recipients. Specific assessment of newer influenza therapeutics in transplant recipients and refinement of prevention strategies are vital to reducing morbidity and mortality.
流感感染对实体器官移植受者构成重大风险，他们往往感染更严重，并发症发生率增加，包括移植物相关并发症。尽管移植受者的流感症状与一般人群相似，但发热并非普遍症状，且淋巴细胞减少症较为常见。建议所有移植受者接种季节性灭活流感疫苗。使用高剂量疫苗或同一季节接种多剂疫苗等新策略似乎可提供更好的免疫原性。神经氨酸酶抑制剂是治疗和化学预防的主要药物，但在移植环境中可能会出现耐药性。流感治疗方法正在不断发展，包括最近批准的巴洛沙韦；然而，许多药物仍需在移植受者中进行评估，尚未常规用于临床。需要开展更多跨越多个流感季节的基于人群的研究，以增强我们对实体器官移植受者中流感流行病学的理解。评估新型流感治疗药物并完善预防策略对于降低发病率和死亡率至关重要。
