對於器官移植病患 H1N1流感有嚴重的後遺症
作者：Jim Kling
出處：WebMD醫學新聞
May 7, 2010 (加州聖地牙哥) — 根據發表於2010年美國移植研討會的一篇研究，對於實質器官移植(solid organ transplant，SOT)病患而言，H1N1流感有嚴重的後遺症。
在2009/10年的H1N1流感大流行中，Alberta大學的研究者決定研究影響它對成人和小兒SOT接受者之後果的因素，為此，他們對美國和加拿大在2009年4至11月間、微生物確認感染H1N1的病患，進行了案例病歷回顧。
辨識的115個案例中，38人是腎臟移植、23人是肝臟移植、22人是心臟移植、18人是肺部移植、14人是其他器官移植。研究對象為76名成人(年紀中位數49歲)與39名孩童(年紀中位數8歲)，移植後時間中位數為3.8年(範圍從2週-21.9年)，整體有61.1%的病患為淋巴細胞減少型、65.2%的病患曾經住院，此外，25.2%曾經發生肺炎、13.0%住進加護病房(ICU)，1名病患死亡。
整體而言，91.3%的病患接受抗病毒治療，一般是oseltamivir 單一治療。多變項分析(P< .05)顯示，比較可能發生住院的是：發燒 (P< .001)、最近使用抗淋巴細胞免疫球蛋白治療(P= .04)或延遲抗病毒治療(P= .03)的病患。症狀發生後48小時內接受抗病毒治療者，比較不會住進ICU，36名及早接受抗病毒治療者無人住進ICU，延遲接受抗病毒治療的67人有15人(22.4%)住進ICU (P= .005)。
研究者表示，H1N1病患的發病率風險較高。Alberta大學內科助理教授Deepali Kumar醫師在發表時表示，在症狀發生48小時內及早進行抗病毒治療，與較少重症有關，當SOT病患出現類流感症狀時，即應給予抗病毒藥物。
根據會議主持人、威斯康辛大學心衰竭移植計畫醫療主任、內科教授Maryl Johnson醫師向Medscape Transplantation表示，研究發現令人鼓舞，當組織架構到位、且授權進行時，醫師可以有效且迅速地反應。
若未來發生爆發時，這個研究結果對醫師們而言有其價值。會議共同主持人、波士頓麻州綜合醫院外科教授Joren Madsen醫師向Medscape Transplantation表示，這是一個重要的研究，將有助於在下波疫情來臨時引導我們。
該研究接受Adamas Pharmaceuticals和Roche Organ Transplant Research基金會的商業補助，Johnson醫師和 Madsen醫師皆宣告沒有相關財務關係。
美國移植研討會(ATC)2010：摘要5。發表於2010年5月2日。
H1N1 Flu Has Serious Consequences for Organ Transplant Patients
By Jim Kling
Medscape Medical News
May 7, 2010 (San Diego, California) — H1N1 influenza infection can have serious consequences for solid organ transplant (SOT) patients, according to a study presented here at the American Transplant Congress 2010.
In the midst of the H1N1 flu pandemic of 2009/10, researchers at the University of Alberta, in Edmonton, set out to determine what effect it had on both adult and pediatric SOT recipients. To that end, they conducted a chart review of cases with microbiologically confirmed H1N1 infection between April and November of 2009 in the United States and Canada.
Of the 115 cases identified, 38 were kidney transplants, 23 were liver transplants, 22 were heart transplants, 18 were lung transplants, and 14 involved other organs. Of the study participants, 76 were adults (median age, 49 years) and 39 were children (median age, 8 years). Median time since transplant was 3.8 years (range, 2 weeks to 21.9 years). In all, 61.1% of patients were lymphopenic and 65.2% of patients were hospitalized. Also, 25.2% experienced pneumonia and 13.0% were admitted into the intensive care unit (ICU). One patient died.
Overall, 91.3% of patients received antiviral therapy, typically oseltamivir monotherapy. A multivariate analysis (P?< .05) showed that hospitalization was more likely to occur in patients with fever (P?< .001), recent antilymphocyte globulin therapy (P?= .04), or delayed antiviral therapy (P?= .03). Those who received antiviral treatment within 48 hours of symptom onset were less likely to be admitted to the ICU — 0 of 36 patients who received early antiviral treatment were admitted to the ICU, compared with 15 of 67 patients (22.4%) who received late antiviral treatment (P?= .005).
The researchers concluded that patients with H1N1 are at risk for significant morbidity. "Early antiviral therapy — within 48 hours of symptoms — was associated with less severe disease. Antivirals should be administered [when SOT patients present] with flu-like illness," Deepali Kumar, MD, MSc, FRCPC, assistant professor of medicine at the University of Alberta, said during her presentation of the research.
The findings are encouraging, according to Maryl Johnson, MD, professor of medicine and medical director of the Heart Failure Transplant Program at the University of Wisconsin in Madison, who comoderated the session. "It shows that clinicians can respond effectively and rapidly when the organization structure is in place to allow them to do that," Dr. Johnson told Medscape Transplantation.
The study results should be valuable to clinicians in future outbreaks. "It's a critical study. It's going to guide us the next time this comes around, which it will," Joren Madsen, MD, DPhil, professor of surgery at Massachusetts General Hospital in Boston, and a session comoderator, told Medscape Transplantation.
The study did not receive commercial support. Dr. Kumar has disclosed no relevant financial relationships..
American Transplant Congress (ATC) 2010: Abstract?5. Presented May?2, 2010.
