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

ABSTRACT

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.

KEYWORDS:

• Allograft dysfunction
• Antiviral therapy
• Influenza
• Transplant Recipients
• Vaccine

Article highlights

• Influenza is associated with significant morbidity in SOT recipients. This includes high hospitalization and intensive care unit admission rates, increased mortality, and association with impaired allograft outcomes.

• Early antiviral therapy and seasonal vaccination are the main contributors to improving the outcome of influenza in SOT recipients.

• Recent studies testing new vaccination strategies in SOT recipients have showed promising results with the use of high-dose vaccines and booster-dose administration.

• Neuraminidase inhibitors, particularly oseltamivir, are the cornerstone of influenza treatment. Baloxavir is a recently developed antiviral with a new mechanism of action that increases the antiviral armamentarium against influenza. However, no data on the use of baloxavir are available in SOT recipients to date.

• Further studies are needed to assess the magnitude of vaccine hesitancy in SOT recipients and transplant physicians, and potential strategies for increasing vaccine acceptance rates.

Declaration of interest

O Manuel has received a research grant from Lophius Bioscience. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.