New H1N1 flu advisory for cardiopulmonary transplantation

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As the H1N1 influenza, or swine flu, has reached pandemic status, there are additional challenges for cardiopulmonary transplant recipients and donors, as well as for the healthcare workers involved in the transplant process, based on an advisory published Oct. 23 in the Journal of Heart and Lung Transplantation.

"Nowhere is the threat of H1N1 more real than in cardiopulmonary transplantation. The ISHLT's [International Society for Heart & Lung Transplantation] Infectious Disease Council has developed what is assuredly the most comprehensive and clinically relevant direction for prevention and management of H1N1 flu in donors, recipients, care providers and family members," said Mandeep R. Mehra, MBBS, editor-in-chief of the Journal of Heart and Lung Transplantation.

Recognition of the H1N1 influenza virus, aggressive diagnosis and early treatment need be paired with active preventative measures to stem the impact of infection in the transplant population, Mehra and colleagues said.

According to the authors, this special advisory addresses issues relevant to cardiothoracic transplant candidates, selection of donors, recipient management and patients with mechanical circulatory support devices. Since transplant recipients are treated with anti-rejection drugs, the advisory provides clear directions for specific dosing of antiviral drugs and management of the background immunosuppression.

Specific guidelines for evaluation and management of post-surgical transplant patients also are given, as well as recommendations for how and when to administer vaccines. On the donor side, the advisory provides guidelines for how to evaluate and treat donors so that organs can be safely used and not wasted. Finally, it provides specific guidelines for the healthcare teams managing such patients.

Author Lara A. Danziger-Isakov MD, Cleveland Clinic Children's Hospital, said that the interaction with “organ procurement organizations for organ selection must take into account emerging data on the use of organs from patients infected and treated for the novel 2009 H1N1 Influenza virus. Improved diagnostic testing with shorter turnaround times is needed in donor evaluation.”

“Individual patient education, prevention measures and treatment strategies will also require attention to the local patterns of infection, availability of the novel 2009 H1N1 Influenza virus vaccination, and emerging patterns of antiviral resistance,” the authors wrote. “Finally, efforts to contain and prevent the novel 2009 H1N1 Influenza virus from spreading within the cardiothoracic transplant setting can be accomplished through infection control measures."

This article is an initiative of the Infectious Disease council of ISHLT to provide practical guidance for cardiothoracic transplant programs facing a winter pandemic of the novel H1N1 influenza, said Margaret M Hannan, MD, Mater Misericordiae University Hospital in Dublin, chairman of ID council for ISHLT.

"Evolving diagnostic testing with limitations due to prolonged turnaround time and availability are considered in donor and recipient management,” Hannan said. “Ensuring that the most accurate diagnostic tests are being carried out in a timely and systematic manner will allow cardiothoracic transplant surgeons to make informed decisions in 'real time' and avoid waste of usable organs."