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P-1.03 Clinical outcomes of influenza infection among solid organ transplant recipients in ICU

Abstract

Clinical outcomes of influenza infection among solid organ transplant recipients in ICU

Aykan Gulleroglu1, Tunay Kandemir1, Tugba Yalcin1, Ender Gedik1, Pinar Zeyneloglu1, Mehmet A. Haberal2.

1Anaesthesia, Baskent University, Ankara, Turkey; 2Transplantation, Baskent University, Ankara, Turkey

Introduction: Influenza is usually a self-limited illness in healthy adults, but influenza virus infection can cause severe illness in certain high-risk groups like solid organ transplant recipients (SOTR). We aimed to evaluate the clinical results of SOTR with influenza admitted to the intensive care unit (ICU).
Materials and Methods: Data of SOTR with influenza related ICU admission in a single center were analyzed between May 2016 to September 2019 retrospectively. Demographics, type of influenza virus, treatment duration, complications and mortality in ICU were assessed.
Results: A total of 115 cases of influenza with SOTR were hospitalized. Out of these 17, %35 were female and 1 was a pediatric patient admitted to ICU due to acute respiratory failure. The median age of 17 patients consisting of 11 kidney and 6 liver recipients was 41 years (range 12-81years). Seven (41%) patients were in chronic rejection. Mean APACHE II and SOFA scores at ICU admission were 17±7.1 and 6.6±2.0 respectively. Except for one patient (<3 months), all were infected with influenza in the late period (>1 year) after transplantation. While real-time polymerase chain reaction (PCR) test was positive in 13 (76.5%) patients, other 4 (23.5%) were diagnosed with rapid antigen testing. The subtypes of influenza were revealed as: 2 (11.8%) influenza A, 13 (76.5%) influenza B, 2 (11.8%) influenza A and B. Simultaneous respiratory syncytial virus (RSV) positivity was seen in 9 SOTR (1 influenza A, 1 influenza A and B, 7 influenza B). Five patients were isolated due to extensively drug-resistant infections. Oseltamivir treatment was applied 5 or 10 days according to disease severity which was 58.8% and 41.2% respectively. Three (17.6%) patients received invasive mechanical ventilation and 10 (58.8%) high flow oxygen therapy for acute respiratory failure. Eight (47.0%) had vasopressor support due to shock and 7 (41.1%) patients received renal replacement therapy. The length of ICU and hospital stay were as 5.6±7.6 days and 18.2±19.0 days respectively. According to APACHE II scoring, mean predicted mortality was 17.0%, while 2 (11.7%) actual deaths were observed.
Discussion: Most of the patients admitted to ICU for influenza were infected after the first year. Influenza B subtype was more common than A, and this was high in RSV accompaniment.
Conclusion: Our study highlightes that, when the symptoms of influenza appear in high risk groups like solid organ transplant recipients, the early initiation of antiviral therapy can be a significantly lifesaving approach.

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