All patients that had a confirmed case of pandemic influenza in our lung transplant program are reported. Demographic data, transplant date, type of transplant, pre-transplant diagnosis, lung function, symptoms and radiographic abnormalities were collected. Treatment and outcomes were noted.
There were three patients that met our criteria. All three were male of Caucasian origin and were diagnosed in June 2009. Their median age was 61 years (range 61-68). All three were single lung transplant recipients (two right, one left). The pre-transplant diagnosis was idiopathic pulmonary fibrosis for two patients and emphysema for the third one. Two patients had family contacts who developed viral illnesses prior to becoming ill. Symptoms included dyspnea, cough, sputum production and fever at presentation. One patient had significant diarrhea with resultant tachycardia as the original reason for hospital admission. All patients had allograft dysfunction prior to the influenza infection (bronchiolitis obliterans syndrome(BOS); 2 had BOS 0-p, 1 had BOS 3). One patient was being evaluated for re-transplant, while another had recently completed radiation therapy for native lung lung cancer. X-ray findings included consolidation consistent with pneumonia in one patient and were reported as clear in the other two patients. CT scan showed ground glass multifocal opacities in two patients. All patients were treated with discontinuation of their azathioprine or mycophenolate mofetil and received increased doses of prednisone, broad spectrum antibiotics and oseltamivir. One patient died three days later of respiratory failure, while the other two recovered. Follow-up lung function in one patient revealed a significant decline (1.27L to 0.72L).CONCLUSIONS: H1N1 influenza appears to be associated with significant morbidity in lung transplant patients, similar to infections with other respiratory viruses in this population.