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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2015  |  Volume : 26  |  Issue : 5  |  Page : 1006-1008
Novel H1N1 influenza infection among post-renal transplantation subjects: A mini review

1 Sanitation 1 Medical Academic Center, Bangkok, Thailand
2 Hainan Medical University, China; Faculty of Medicine, University of Nis, Serbia; Joseph Ayobabalola University, Nigeria; Surin Rajabhat University, Thailand

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Date of Web Publication7-Sep-2015

How to cite this article:
Joob B, Wiwanitkit V. Novel H1N1 influenza infection among post-renal transplantation subjects: A mini review. Saudi J Kidney Dis Transpl 2015;26:1006-8

How to cite this URL:
Joob B, Wiwanitkit V. Novel H1N1 influenza infection among post-renal transplantation subjects: A mini review. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2022 Nov 26];26:1006-8. Available from: https://www.sjkdt.org/text.asp?2015/26/5/1006/164592
To the Editor,

Swine flu is at present one of the major problems of the world. Post-renal transplantation subjects can also be infected with swine flu, and this becomes an interesting problem among transplant infectious disease. This mini-review briefly summarizes this subject with a critical review of the current literature.

Swine flu is an emerging infectious disease. This disease is caused by a novel H1N1 influenza virus. The first outbreak of this disease was identified in Mexico. After that, it spread to other countries around the world. [1] The pandemic of swine flu can be seen around the world and the World Health Organization already recognizes the existence of this problem. Many millions are already infected by the swine flu virus and thousands of deaths have been reported. The main clinical manifestation of swine flu is the respiratory manifestation. Upper respiratory tract infection is common in swine flu. [2] Cough, running nose and fever can be seen in almost all the cases. [2] In severe cases, progression of infection into the lower respiratory tract and lung can be expected. Pneumonia is common in this scenario, and this can be the cause of death.

In addition to the respiratory manifestation, other systemic manifestations also can be expected. [3] Of several non-respiratory manifestations, renal manifestation can naturally be expected and are seen in renal patients. [4] However, renal complication due to novel H1N1 influenza infection and clinical manifestation of this new emerging infection among renal failure patients are still rare in nephrology. [4]

In a specific scenario of renal transplantation, at present, swine flu does become a concern. Because swine flu is a respiratory viral infection, the pathogenic virus can be seen as a contaminant in the environment. Similar to the general population, the renal transplant cases can get exposure to the pathogenic virus and can get infected. However, there are not many reports on this specific issue. This might be due to the fact that the proportion of the renal transplant cases to the general population is very low. Hence, it is not surprising that there are only a few cases of swine flu reported in renal transplant patients. According to the literature search, there are less than 10 reports on this topic. The recent publication on novel H1N1 influenza infection among post-renal transplantation subjects by Watcharananan et al is a pioneer report in this specific issue. Watcharananan et al [5] concluded that "Despite early antiviral treatment, we showed that morbidity following novel pandemic influenza A/H1N1 2009 infection is high among kidney transplant recipients". [5] The patient in this report rapidly died of pneumonia. Another important report is by Troppmann et al, [6] in which they reported a rapidly progressive lethal infection with novel H1N1 2009 virus in a kidney recipient. [6] It might seem likely that the disease has a higher severity in renal transplant cases compared with the other populations. However, there are some concerns on these reports. First, these works are only case reports. The conclusion on the morbidity of novel H1N1 influenza infection might be an extrapolation. Indeed, there was no proof for the increased morbidity or mortality of infection among the post-renal transplantation cases. Based on the registered data on death cases of swine flu in Thailand, although there are some cases of death among renal dialysis patients, there is no case of death reported among post-renal transplantation patients. Second, the development of pneumonia is not a rare condition for novel H1N1 influenza infection. This complication can develop in either healthy or immunocompromised subjects. [1] However, the need for close observation on the post-renal transplant cases with swine flu is required. This is based on the fact that these patients have poor baseline health status. Vallejos mentioned needs on specific "protocols for assessment and treatment in order to lessen the impact of the pandemic in renal patients". [7] Focusing on the management of swine flu infection among renal transplant cases, standard antiviral therapy is still recommended. [2] Oseltamivir is still effective and causes no problem in renal transplant patients. [2] Furthermore, a modification of dosage is not required. [2] Marfo et al reported that "Postexposure prophylaxis with oseltamivir was effective to prevent H1N1 influenza A virus in a donor and a recipient". [8] However, there is a recent interesting report on the failure of usage of standard oseltamivir treatment from Australia. [9] In this report, a renal transplant recipient developed rapid-onset severe primary viral pneumonia due to oseltamivir-resistant virus and the treatment had to move to intravenous zanamivir. [9]

A great success in medicine for fighting swine flu is the development of a swine flu vaccine. [10] Indeed, looking for a new and effective drug and vaccine for swine flu is the hope for success in combating swine flu. [11] At present, a new swine flu vaccine is available and is being used in many countries. The use of vaccine is recommended for everyone in the pandemic scenario, including to the post-renal transplantation cases. Because the new swine flu vaccine is developed in pandemic vaccine mode, the lack for the complete effectiveness and safety evaluation in specific populations including to the renal transplant patients can be expected. However, based on the existing evidence on the classical H1N1 influenza vaccine, safe [12] but decreased antibody response to influenza vaccination in renal transplant recipients could be observed, [13] and this is expected for the case of swine flu vaccination.

Another important concern in renal transplantation practice is the possibility of transplantation-transmitted swine flu. Indeed, this mode of transmission is considered difficult as the period of viremia in swine flu is very short and there is no evidence of accumulation of virus in any organ. In addition, the virus has no pathway to the kidney. Hence, infection among the renal transplant patients is usually via air-borne transmission similar to the general population. There is an interesting report related to this topic. Lettes et al recently reported that "kidneys from donors who have had confirmed influenza A/H1N1 and who have received antiviral treatment can be safely used in transplantation". [14]

The problem of swine flu among renal transplant recipients do exist and has become a concern among transplant infectious diseases. Although there is no clear evidence, the infection among renal transplant recipients might manifest a more severe presentation than that of the general population. The treatment for swine flu in renal transplant recipients can follow the general practice as for the general population. Focusing on swine flu vaccination, although it is recommended, the complete data of effectiveness and safety for renal transplant recipients is not presently available.

Conflict of interest: None declared.

   References Top

Wiwanitkit V. Swine flu: The present pandemic infectious disease. Kulak Burun Bogaz Ihtis Derg 2009;19:57-61.  Back to cited text no. 1
Wiwanitkit V. Antiviral drug treatment for emerging swine flu. Clin Ter 2009;160:243-5.  Back to cited text no. 2
Wiwanitkit V. Non respiratory manifestations of swine flu. Clin Ter 2009;160:499-501.  Back to cited text no. 3
Wiwanitkit V. Renal failure in swine flu: An appraisal from Thailand's story. Ren Fail 2010;32:150.  Back to cited text no. 4
Watcharananan SP, Suwatanapongched T, Wacharawanichkul P, Chantratitaya W, Mavichak V, Mossad SB. Influenza A/H1N1 2009 pneumonia in kidney transplant recipients: Characteristics and outcomes following high-dose oseltamivir exposure. Transpl Infect Dis 2010;12:127-31.  Back to cited text no. 5
Troppmann C, Cohen S, de Mattos A, Perez R. Rapidly progressive lethal infection with novel influenza A (H1N1) 2009 virus in a kidney recipient: A cautionary tale. Transplantation 2010 15;89:369-70.  Back to cited text no. 6
Vallejos A. The role of nephrology in the influenza A (H1N1) pandemic update. Nefrologia 2009;29:576-81.  Back to cited text no. 7
Marfo K, Chapochnick-Friedmann J, Akalin E, Lu A. Postexposure prophylaxis of H1N1 with oseltamivir in a newly transplanted kidney recipient receiving intense immunosuppressive therapy. Transplant Proc 2009;41:4411-3.  Back to cited text no. 8
Speers DJ, Williams SH, Pinder M, Moody HR, Hurt AC, Smith DW. Oseltamivir-resistant pandemic (H1N1) 2009 influenza in a severely ill patient: The first Australian case. Med J Aust 2010;192:166-8.  Back to cited text no. 9
Wiwanitkit V. Swine flu vaccine: Present status. Hum Vaccin 2009;5:777-8.  Back to cited text no. 10
Wiwanitkit V. Finding a new drug and vaccine for emerging swine flu: What is the concept? Biologics 2009;3:377-83.  Back to cited text no. 11
Birdwell KA, Ikizler MR, Sannella EC, et al. Decreased antibody response to influenza vaccination in kidney transplant recipients: A prospective cohort study. Am J Kidney Dis 2009;54:112-21.  Back to cited text no. 12
Candon S, Thervet E, Lebon P, et al. Humoral and cellular immune responses after influenza vaccination in kidney transplant recipients. Am J Transplant 2009;9:2346-54.  Back to cited text no. 13
Lattes R, Jacob N, de la Fuente J, Fragale G, Massari P. Pandemic influenza A/H1N1 and organ donation. Transpl Infect Dis 2010;12:169-72.  Back to cited text no. 14

Correspondence Address:
Dr. Beuy Joob
Sanitation 1 Medical Academic Center, Bangkok, Thailand

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-2442.164592

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