Each year 3-5 million people have severe cases and 250-500,000 die from complications of seasonal influenza world-wide. This year, the novel 2009 H1N1 (nH1N1) influenza, previously called swine flu, has reached pandemic status. Since novel 2009 H1N1 is a viral infection of the respiratory tract, there are additional challenges for cardiopulmonary transplant recipients and donors, as well as for the healthcare workers involved in the transplant process. In an article published online today in The Journal of Heart and Lung Transplantation (www.jhltonline.org), physicians representing the International Society for Heart & Lung Transplantation (ISHLT) Infectious Disease Council issue an advisory for all programs in cardiothoracic transplantation.
Mandeep R. Mehra, MBBS, FACC, FACP, Editor-in-Chief, The Journal of Heart and Lung Transplantation observes, "Nowhere is the threat of H1N1 more real than in cardiopulmonary transplantation. The ISHLT's 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."
Recognition of the novel 2009 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. 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 are also 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.