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Adverse Occurrence type:
Rare. Two cases of probable transmission of influenza have been reported.
Time to detection:
1 day (lung)
Alerting signals, symptoms, evidence of occurrence:
9-year-old donor had been febrile and probably had a seizure on the day of a submersion injury. Went on to donate organs after a 60 hour admission to hospital; his nasopharyngeal aspirate was positive for Influenza B virus by immunofluorescence, later also confirmed by polymerase chain reaction (PCR). Lungs, kidneys and liver had been accepted. LUNG: Recipient was a 14 year old girl who had received seasonal influenza vaccination. Widespread crackles were noted on chest auscultation on post operative day 0; she developed hypoxia and required assisted ventilation. Chest x-ray demonstrated diffuse bilateral interstitial infiltrates. BAL was positive for influenza B virus by direct immunofluorescence and culture on post operative days 0 and 1. She received 10 days of Oseltamivir and made good recovery. LIVER: Recipient was a 8 year old boy, received 10 days of Oseltamivir. No signs or symptoms of influenza illness at any point. KIDNEY: Recipient was a 14 year old boy who had not received seasonal influenza vaccination in that year. A biopsy of the kidney graft was reported to be positive for Influenza B by PCR but this is an unsual result and no further details were provided by the authors. The patient developed fever and respiratory distress 30 hours post transplant but extensive investigations in blood, respiratory secretions and kidney biopsy were negative for Influenza B; there was no subsequent serological indication of Influenza infection. Oseltamivir was given for 6 days. The diagnosis of influenza B in this recipient is doubtful.
Demonstration of imputability or root cause:
Influenza B virus detected in donor. Kidney and lung recipients had Influenza B detected in kidney tissue and in BAL, respectively, by PCR, culture and direct immunofluorescence. Both recipients' Influenza strains typed as B/Florida/4/2006. Phylogenetic analysis based on partial nonstructural gene showed that the kidney and lung recipient strains were closely related with 98.9% amino acid identity. The strains shared more than 97.8% amino acid identity with B/Florida/4/2006, the strain in the Australian 2008 to 2009 vaccine. Partial non-structural sequence analysis with this level of homology may not be sufficient to prove common source of infection other than matching the circulating strain in that season; more extensive sequencing would have been preferred.
Suggest new keywords:
Influenza A virus, influenza, seasonal influenza, influenza vaccine, Oseltamivir, bronchoalveolar lavage, immunofluorescence, PCR, viral culture, pulmonary infiltrates, hypoxia, assisted ventilation
- Influenza B virus transmission in recipients of kidney and lung transplants from an infected donor - Influenza transmission to recipient through lung transplantation
I'd leave as lung and not clone for kidneys as the evidence of Flu in the kidneys is somewhat doubtful.....? (Ines)
Expert comments for publication:
There are 2 reported cases in the literature describing possible donor derived transmission of influenza A and Influenza B viruses. Guidance on suitabiity of organs from donors infected with seasona influenza virus may vary, but the general views are that organs other than the lungs, including bowel, should be considered for donation. Readers are advised to read available guidance from various transplant societies (eg US, Australia&New Zealand, UK). Case by case assessment of risk-benefit of transplanting lungs from infected donors is required. As the spectrum of infection is broad, incidental or concomitant detection of virus in the donor may not represent contra-indication for donation unless there is clear lower respiratory tract involvement. Both donor and recipient can have interventions to minimise risk of complications in the recipient, such as anti-viral treatment or prophylaxis, and these must be considered. Vaccination of patiets in the transplant waiting list remain an important prophylactic measure. It must be emphasised that these notes refer to seasonal influenza only and not to pandemic or avian influenza.