Influenza in solid organ transplant recipients: epidemiology, management, and outcomes

Introduction: In solid organ transplant (SOT) recipients, influenza is associated with significant morbidity, including high hospital admission and mortality rates. Influenza may also impair allograft outcomes, in particular in lung transplant recipients. Early treatment with antivirals and seasonal vaccination contribute to reduce influenza-associated morbidity in this population.Areas covered: We selected a number of publications by searching into Pubmed to review the epidemiology, clinical presentation, outcomes, and management of influenza in SOT recipients. We discuss current treatment options and recent advances in the development of new vaccination strategies.Expert opinion: Our review showed that despite recent studies addressing the current epidemiology of influenza in SOT recipients, data in this population remain sparse. Large international multi-season cohort studies should better describe the actual burden of influenza. Although oseltamivir is an effective drug and should be given to all SOT recipients, the use of novel antivirals and combination therapies need to be tested prospectively in this population. Finally, recent studies aiming to improve the immunogenicity of influenza vaccine in SOT recipients showed promising results, in particular with the use of high-dose vaccines and booster-dose. Clinical trials using clinical endpoints would be important to foster the introduction of these vaccines in the routine clinical practice.