Increased mortality of solid organ transplant recipients with H1N1 infection: a single center experience

Immunosuppressed solid organ transplant recipients are included in the cohort at increased risk for complications of viral infections such as the newly encountered H1N1. A retrospective review was performed to collect data on patients hospitalized during a recent H1N1 epidemic. H1N1 was suspected based on symptoms and real-time reverse-transcriptase-polymerase-chain-reaction assay confirmed the diagnosis. From August through October of 2009, 89 patients were admitted to The Methodist Hospital, Houston, Texas, with H1N1. Eighteen were solid organ transplant recipients with an age range of 34-69 yr. This group included nine kidney, five lung, one kidney-pancreas, one liver, and two heart recipients. Severe cardiac or pulmonary comorbidities existed in over half of non-transplant patients, while only eight of these non-transplant patients were otherwise healthy. Eighty-nine percent of transplant patients presented with fever or chills, 72% with cough, and 56% with gastrointestinal distress. Symptoms were similar to non-transplant patients. All transplant patients were treated with oseltamivir. Two non-transplant patients and three transplant patients died. Thirty-day survival was 97% in non-transplant and 83% in transplant patients (p=0.02). In the context of an initial epidemic of H1N1, infection was associated with increased risk of complications and mortality in solid organ transplant recipients.