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Abstract
Background
Novel H1N1 influenza A was a pandemic disease in 2009. However, limited data are available on renal transplant recipients undergoing long-term immunosuppression who contracted novel H1N1 influenza A.
Methods
We analyzed 2,345 patients who had been tested with H1N1 swab real-time reverse transcriptase-polymerase chain reaction test (rRT-PCR) between May 2009 and February 2010. Of them, 30 were kidney recipients who underwent kidney transplantation between April 1979 and 2, May 2009 before the first diagnosis of H1N1 influenza A in Korea. The clinical characteristics, treatment, and outcome of renal transplant recipients with confirmed H1N1 influenza were reviewed retrospectively.
Results
A total of 1,543 (66.7%) general patients were swine influenza A confirmed. Of the 30 transplant patients, 19 (63.3%) were confirmed with swine influenza A. The mean age of the general patients at diagnosis of swine influenza A was younger than that of renal recipients (16.5±16.1 vs. 39.7±11.5 years, P＜0.0001). More patients died in the transplant group than in the general patient group even after oseltamivir (Tamiflu) treatment. When comparing the cured group with the dead group of transplant patients, the dead group had a longer duration between symptom manifestation and the beginning of treatment than the cured group (7 [5–7] vs. 2 [1–14] days, P=0.007). The dead group presented more complications such as pneumonia (P=0.009).
References
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Table 1.
Comparison of clinical characteristics in general versus transplant patients
Table 2.
Clinical characteristics of three transplant groups
| Factors | Group A a | Group B b | Group C c | P |
|---|---|---|---|---|
| Sex | 0.121 | |||
| Male | 1,253 | 5 | 9 | |
| Female | 695 | 6 | 10 | |
| Age at transplantation | 38 (2∼71) | 27 (15∼51) | 44 (9∼54) | 0.078 |
| Main immunosuppressive agent | 0.784 | |||
| Azathioprine | 41 (2.1%) | 0 (0.0%) | 0 (0.0%) | |
| Cyclosporine A | 1,433 (73.6%) | 7 (63.6%) | 14 (73.7%) | |
| Tacrolimus | 474 (24.3%) | 4 (36.4%) | 5 (26.3%) | |
| Antimetabolite | 0.918 | |||
| Yes | 1,035 (53.1%) | 6 (54.5%) | 9 (47.4%) | |
| No | 913 (46.9%) | 5 (45.5%) | 10 (53.6%) | |
| Retransplantation | 0.739 | |||
| Yes | 159 (8.2%) | 0 (0.0%) | 2 (10.5%) | |
| No | 1,789 (91.8%) | 11 (100%) | 17 (89.5%) | |
| Acute rejection episode | 0.433 | |||
| Yes | 469 (24.1%) | 1 (9.1%) | 6 (31.6%) | |
| No | 1,479 (75.9%) | 10 (90.9%) | 13 (68.4%) |
Table 3.
Factors that affect to the treatment outcome in transplant patients
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