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Early oseltamivir initiation and influenza outcomes in kidney transplant recipients: a multicenter real-world study
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DOI：10.1186/s12879-026-14013-y.png)
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Abstract
En 中文
Influenza infection poses a significant clinical threat to kidney transplant recipients due to their immunocompromised status. Although current guidelines recommend early antiviral therapy, real-world evidence supporting the effectiveness of oseltamivir, particularly regarding the optimal timing of initiation in this vulnerable population remains scarce. To identify independent factors associated with clinical improvement and time to symptom resolution in kidney transplant recipients infected with the influenza virus and treated with oseltamivir. We conducted a multicenter retrospective study enrolling adult kidney transplant recipients diagnosed with influenza virus infection across five centers between October 2023 and March 2024. Clinical outcomes were assessed using a validated Composite Symptom Score (range: 0–21) based on seven typical influenza symptoms. Clinical improvement was defined as achieving a score of ≤ 1 on the fifth day after oseltamivir initiation. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with clinical improvement, and linear regression was used to evaluate factors influencing time to symptom resolution. Given the small number of events, the multivariable logistic model was estimated using Firth’s penalized likelihood method and restricted to two core predictors. A total of 58 kidney transplant recipients were included. After one course of oseltamivir, 46 patients (79.3%) achieved clinical improvement. Compared with the improved group, patients without improvement had a significantly lower rate of early oseltamivir initiation (≤ 48 h: 58.3% vs. 84.8%, P = 0.044) and tended to present with higher baseline symptom scores. In multivariable logistic regression, oseltamivir initiation > 48 h was the only factor independently and significantly associated with reduced likelihood of clinical improvement (adjusted OR = 0.16, 95% CI: 0.03–0.76, P = 0.030), after adjusting for onset symptom score using Firth’s penalized likelihood logistic regression to account for the small number of events. Higher baseline onset symptom score was also significantly associated with unfavorable outcomes (adjusted OR = 0.77, 95% CI: 0.63–0.91, P = 0.007). Consistently, multivariable linear regression confirmed that late oseltamivir initiation was independently associated with prolonged time to symptom resolution (β = 5.02, 95% CI: 3.00–7.04, P < 0.001). Neither dosage adjustment nor treatment duration extension was significantly associated with clinical outcomes. In this multicenter real-world study, early oseltamivir initiation (≤ 48 h) was the strongest independent predictor of both clinical improvement and a shorter symptom resolution time in kidney transplant recipients with influenza. Baseline disease severity showed a trend-level association with unfavorable outcomes, suggesting a narrowing “window of opportunity” for a therapeutic response in patients with a higher symptom burden. These findings reinforce the critical importance of prompt antiviral intervention in immunocompromised transplant recipients and provide real-world evidence to support clinical decision-making for early treatment prioritization.
Keywords:
Kidney transplantation
Influenza infection
Oseltamivir
Early antiviral initiation
Clinical improvement
Real-world study
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