Late cytomegalovirus (CMV) infections after kidney transplantation under the preemptive strategy: Risk factors and clinical aspects.

BACKGROUND: Late cytomegalovirus infections (LCMV) after the cessation of prophylaxis are well described. We aimed to assess clinical and epidemiological data on late-occurring cytomegalovirus (CMV) infections in the absence of CMV prophylaxis in a cohort of kidney transplant patients. METHODS: In a cohort of kidney transplant recipients not employing CMV-specific prophylaxis, patients with CMV infections occurring after 6 months of transplantation were compared to patients with CMV infections diagnosed within the first 6 months (early infections). The main objectives were to compare clinical outcomes and evaluate risk factors for late CMV infection. RESULTS: A total of 556 patients were evaluated. Forty-three patients with LCMV infections were compared to 513 patients with early CMV infections. LCMV infections occurred after a median of 473 days of transplantation and had a more severe course, with a statistically significant higher rate of invasive disease and graft loss (60.5% vs 21.6% and 11.6% vs 3.1% respectively). Thirty-day mortality was twice as high for patients with LCMV, but did not reach statistical significance (9.3% vs 4.3%). By multivariate analysis, employment of antilymphocyte therapy early after transplantation and tacrolimus as initial immunosuppressive therapy were significantly protective for the occurrence of LCMV infections. CONCLUSION: Late CMV infections in the absence of specific prophylaxis after kidney transplantation have a more severe outcome when compared to early infections and occur in patients less immunosuppressed early after transplantation.

Morbimortality of pandemic influenza A H1N1 infection in kidney transplant recipients requiring hospitalization: a comparative analysis with nonimmunocompromised patients.

BACKGROUND: Clinical and epidemiological data of pandemic influenza A H1N1 infection in solid-organ transplant recipients have been described, but scarce data compare these outcomes with nonimmunocompromised patients. METHODS: We retrospectively reviewed and compared the clinical presentation, morbidity, and mortality of all kidney transplant (KT) and nonimmunocompromised (non-KT) patients admitted for at least 12 hr with a diagnosis of pandemic influenza A H1N1 infection in a single hospital complex during the 2009 pandemic. RESULTS: There were 22 patients in the KT group (29.3%) and 53 in the non-KT group (70.7%). The prevalence of diabetes was higher in KT group (27.3% vs. 5.7%) while chronic pulmonary disease was more frequent in non-KT group (34% vs. 9.1%). Clinical and radiological presentations and duration of disease were similar between the two groups. The incidence of acute renal failure was higher among KT patients (40.9% vs. 17%). No differences in the rate of intensive care unit admission (22.7% vs. 22.6%) or hospital mortality (9.1% vs. 7.5%) were observed. For the overall population, poor outcome, defined as intensive care unit admission or death, was associated with in-hospital acquisition (relative risk [RR]=42.6 [95% confidence interval {95% CI } 2.2-831.9], P=0.003), symptom onset more than 48 hr (RR=12.17 [95% CI 1.3-117.2], P=0.007), and acute renal failure (RR=11.8 [95% CI 2.9-48.8], P<0.001). Among KT recipients, in-hospital acquisition was the only covariate associate with poor outcome (RR=30.0 [95% CI 2.1-421.1], P=0.004). CONCLUSIONS: No significant differences in morbidity and mortality were observed comparing KT and non-KT patients infected with pandemic H1N1 influenza A virus.

Clinical manifestations and evolution of infection by influenza A (H1N1) in kidney transplant recipients.

INTRODUCTION: The emergence of the pandemic outbreak of influenza A (H1N1) in April, 2009, represented a logistic challenge for public health. Although most infected patients presented clinical and evolutionary manifestations which were very similar to seasonal influenza, a significant number of individuals developed pneumonia and severe acute respiratory failure. The impact of influenza A (H1N1) in immunocompromised patients is not well established yet. METHODS: This study aimed to analyze the clinical presentations and evolution of influenza A (H1N1) in 19 kidney transplant recipients. Influenza A (H1N1) infection was confirmed by RT-PCR in all patients. Treatment included antiviral therapy with oseltamivir phosphate and antibiotics. RESULTS: The studied population was compounded mostly of white people (63%), males (79%), at a mean age of 38.6 ± 17 years and patients with at least one comorbidity (53%). Influenza A (H1N1) infection was identified 41.6 ± 49.6 months after transplantation. Common symptoms included cough (100%), fever (84%), dyspnea (79%), and myalgia (42%). Acute allograft dysfunction was observed in 42% of the patients. Five patients (26%) were admitted to the Intensive Care Unit, two (10%) required invasive ventilation support, and two (10%) required vasoactive drugs. Mortality rate was 10%. CONCLUSIONS: Acute renal allograft dysfunction was a common finding. Clinical, laboratory, and evolutionary characteristics were comparable to those in the general population.

Manifestações clínicas e evolução da infecção pelo vírus da influenza A (H1N1) em receptores de transplante renal / Clinical manifestations and evolution of infection by influenza A (H1N1) in kidney transplant recipients

INTRODUÇÃO: A emergência do surto pandêmico de influenza A, subtipo H1N1, em abril de 2009, representou um grande desafio para a logística de saúde pública. Embora a maioria dos pacientes infectados apresente manifestações clínicas e evolutivas muito semelhantes às observadas na influenza sazonal, um número significativo de indivíduos evolui com pneumonia e insuficiência respiratória aguda severa. O impacto da infecção pelo vírus influenza A, subtipo H1N1, em pacientes imunossuprimidos não é determinado. MÉTODOS: Neste estudo, foram analisadas a apresentação clínica e a evolução da influenza A, subtipo H1N1, em 19 receptores de transplante renal. Os pacientes receberam confirmação diagnóstica pela técnica de RT-PCR. O manejo clínico incluiu terapêutica antiviral com fosfato de oseltamivir e antibióticos. RESULTADOS: A população estudada foi predominantemente de indivíduos do sexo masculino (79 por cento), brancos (63 por cento), com idade média de 38,6 ± 17 anos e portadores de pelo menos uma comorbidade (53 por cento). A infecção por influenza A, subtipo H1N1, foi diagnosticada em média 41,6 ± 49,6 meses após o transplante. Os sintomas mais comuns foram: tosse (100 por cento), febre (84 por cento), dispneia (79 por cento) e mialgia (42 por cento). Disfunção aguda do enxerto foi observada em 42 por cento dos pacientes. Cinco pacientes (26 por cento) foram admitidos em Unidade de Terapia Intensiva, dois (10 por cento) necessitaram de suporte com ventilação invasiva e dois (10 por cento) receberam drogas vasoativas. A mortalidade foi de 10 por cento. CONCLUSÕES: A disfunção aguda do enxerto renal foi um achado frequente, e as características clínicas, laboratoriais e evolutivas foram comparáveis às da população geral.

INTRODUCTION: The emergence of the pan>demic outbreak of influenza A (H1N1) in April, 2009, represented a logistic challenge for public health. Although most infected patients presented clinical and evolutionary manifestations which were very similar to seasonal influenza, a significant number of individuals developed pneumonia and severe acute respiratory failure. The impact of influenza A (H1N1) in immunocompromised patients is not well established yet. METHODS: This study aimed to analyze the clinical presentations and evolution of influenza A (H1N1) in 19 kidney transplant recipients. Influenza A (H1N1) infection was confirmed by RT-PCR in all patients. Treatment included antiviral therapy with oseltamivir phosphate and antibiotics. RESULTS: The studied population was compounded mostly of white people (63 percent), males (79 percent), at a mean age of 38.6 ± 17 years and patients with at least one comorbidity (53 percent). Influenza A (H1N1) infection was identified 41.6 ± 49.6 months after transplantation. Common symptoms included cough (100 percent), fever (84 percent), dyspnea (79 percent), and myalgia (42 percent). Acute allograft dysfunction was observed in 42 percent of the patients. Five patients (26 percent) were admitted to the Intensive Care Unit, two (10 percent) required invasive ventilation support, and two (10 percent) required vasoactive drugs. Mortality rate was 10 percent. CONCLUSIONS: Acute renal allograft dysfunction was a common finding. Clinical, laboratory, and evolutionary characteristics were comparable to those in the general population.