Oseltamivir Pre-Exposure Prophylaxis Does Not Cut Influenza Rates in Lung Transplant Recipients

Individuals who undergo lung transplants are at a higher risk for influenza as well as flu-related complications. Furthermore, due to their compromised immune system, host immune responses are not as strong and therefore the influenza vaccine may not provide protection against the flu in these individuals following transplantation.

In a new study, a team of investigators from the University of North Carolina Medical Center in Chapel Hill investigated the efficacy of oseltamivir for pre-exposure prophylaxis for influenza in individuals who have undergone a lung transplant. The results of the research were presented in a poster session at the Making a Difference in Infectious Diseases 2019 (MAD-ID) annual meeting.

Prior to the study, the efficacy of neuraminidase inhibitors for pre-exposure prophylaxis had not been demonstrated in the lung transplant setting and there was a lack of data to support using pre-exposure prophylaxis in individuals who were recipients of liver, kidney and hematopoietic stem cell transplants.

Therefore, the investigators initiated a retrospective, observational study of patients less than 1 year out from a lung transplant. A total of 86 patients who were 13 years of age or older were enrolled between

September 1, 2012 and April 30, 2018. The primary endpoint of the study was a laboratory confirmed case of influenza within 1 year from the date of transplant.

Patients were enrolled into either the treatment group, made up of patients who received oseltamivir prophylaxis (post-2015 transplants) or the control group, comprised of patients who did not receive oseltamivir prophylaxis (pre-2015 transplants). In total, 54 patients were placed in the control arm and the remaining 32 patients made up the prophylaxis arm, with reported similar baseline characteristics in both arms.

The investigators observed in this study that there was no difference between the 2 groups in the rate of influenza within the first year following a lung transplant (control arm 3.7% vs prophylaxis arm 0%, p=0.5272). Therefore, the authors conclude that oseltamivir prophylaxis in recipients of lung transplants did not reduce the rate of flu occurrence within the first year following the transplant.

However, results could be different at other institutions, the investigators suggest in the abstract. “Further research is needed in this area, particularly at institutions where the rate of influenza in their lung transplant patients is higher,” the authors wrote in the conclusion.

The poster “Efficacy of Oseltamivir for Pre-exposure Influenza Prophylaxis in Lung Transplant Patients,” was presented on Thursday, May 9, 2019 at MAD-ID 2019 in Orlando, Florida.