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Transplantation |

Preemptive Use of Oseltamivir in Lung Transplant Recipients: A One-Year Observational Study of Clinical Characteristics, Outcomes, Comedication and Safety

Christoph Jungo; Stefan Russmann; Macé Schuurmans
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Pulmonology, University Hospital, Zurich, Switzerland


Chest. 2014;146(4_MeetingAbstracts):980A. doi:10.1378/chest.1994697
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Abstract

SESSION TITLE: Lung Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Influenza virus infections in lung transplant recipients (LTRs) have an increased risk of unfavorable outcomes. Early initiation of treatment is associated with improved outcomes. In clinical practice oseltamivir is therefore commonly started even prior to diagnostic microbiological confirmation. There is limited data on the patient characteristics, safety of oseltamivir and outcomes of this practice. The aim of this study is to asses patient and treatment characteristics as well as safety of this preemptive treatment strategy using oseltamivir.

METHODS: Descriptive analysis of LTRs who received oseltamivir for 2 days for suspected influenza infection between 07-2011 and 06-2012. Analyses were based on data from electronic medical records and our standardized LTR database with prospective documentation of clinical information including comedication, laboratory and lung function results, outcomes and adverse events. Viral multiplex Polymerase Chain Reaction (PCR) results are available within 24-48 hours of sampling. LTRs call transplant coordinators 2 days after sampling to receive instructions about treatment modifications based on results.

RESULTS: We included 133 patients with a total of 263 oseltamivir treatment episodes (87.4% as outpatients). Episode-based analyses provided the following key results: Median age 50.2 years, 30% and 70% received 75 and 150 mg/d, respectively, medication duration of oseltamivir treatment 4 days (range 2 to 67), 98.5% had concomitant antibiotic pharmacotherapy. Indications (>1 possible) for oseltamivir were: acute respiratory infection (67%), non-distinctive inflammatory reaction (51%), influenza-like illness (2.7%), other (18%). Influenza virus infection was confirmed by PCR diagnostics in only 7%. Rhinovirus was the most frequent pathogen detected (15%). We discovered a wide range of adverse events but none occurred in >5%, and most were mild and of questionable causal relationship to oseltamivir. None of the patients developed a respiratory infection with an unfavorable outcome.

CONCLUSIONS: While controlled prospective studies are desirable but not available, this non-controlled retrospective analysis suggests that the preemptive use of oseltamivir for respiratory tract infections pending microbiological results is effective and safe.

CLINICAL IMPLICATIONS: We recommend the preemptive use of oseltamivir in lung transplant recipients with suspected respiratory tract infection during the influenza season.

DISCLOSURE: The following authors have nothing to disclose: Christoph Jungo, Stefan Russmann, Macé Schuurmans

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