Can a kidney donor with impending surgery and exposure to influenza A take prophylactic Tamiflu (oseltamivir)?

Kidney Donor Prophylaxis for Influenza A Exposure

A kidney donor with influenza A exposure can safely take prophylactic oseltamivir (Tamiflu) prior to scheduled surgery, as the medication is well-tolerated and does not pose contraindications for healthy donors, though the decision should weigh the timing of surgery against the risk of developing active infection.

Rationale for Prophylaxis Use

While the available guidelines primarily address transplant recipients rather than donors, the evidence supports oseltamivir's safety profile in healthy individuals and its role in preventing influenza transmission:

• Oseltamivir is FDA-approved for prophylaxis of influenza A and B in patients 1 year and older, with standard dosing of 75 mg once daily 1
• The medication has demonstrated safety and tolerability across multiple populations, including immunocompromised patients who would be at higher risk for adverse effects than healthy donors 2, 3
• Prophylaxis is most effective when initiated promptly after known exposure to prevent disease development 4

Key Considerations for the Donor

Timing and Surgery Planning

• If the donor develops symptomatic influenza, surgery should be postponed until the infection resolves to prevent transmission to the recipient and avoid perioperative complications
• The transplant team should monitor the donor closely for any signs of influenza symptoms (fever, cough, myalgia, malaise) during the prophylaxis period 4
• Treatment should be initiated immediately if symptoms develop, as early treatment (within 48 hours of symptom onset) is most effective 1

Dosing for Healthy Donors

• Standard prophylactic dose is 75 mg once daily for the duration of risk exposure, typically 10 days after last known contact with the influenza case 1
• No dose adjustment is needed for healthy donors with normal renal function 4, 5
• The medication can be taken with or without food, though taking it with food may reduce gastrointestinal side effects 1

Safety Profile

• Common side effects are mild and include gastrointestinal upset (nausea, vomiting), which occurred in approximately 16% of prophylaxis recipients in one study 6
• Serious adverse events are rare in healthy individuals 3
• The donor should be counseled to report any behavioral changes, allergic reactions (rash, swelling, difficulty breathing), or worsening symptoms immediately 1

Important Caveats

Limitations of Prophylaxis

• Oseltamivir prophylaxis is not 100% protective and susceptibility to influenza returns once the medication is discontinued 7
• The donor should continue to practice infection control measures including hand hygiene and avoiding contact with symptomatic individuals 4
• Prophylaxis does not replace the need for annual influenza vaccination, though vaccination timing should be coordinated with the transplant team 1

Drug Resistance Considerations

• While oseltamivir resistance can develop, it remains uncommon in community-acquired influenza 4
• If the donor develops symptoms despite prophylaxis, this may indicate infection with a resistant strain and requires immediate medical evaluation 7

Coordination with Transplant Team

• The transplant surgery team must be informed immediately about the influenza exposure to assess whether to proceed with surgery or delay
• Testing the donor for influenza (via PCR) may be warranted if surgery is imminent, even if asymptomatic 4
• The recipient's immunosuppressed state makes them particularly vulnerable to influenza complications, so preventing donor-to-recipient transmission is critical 8

Practical Algorithm

1. Confirm influenza A exposure and timing relative to scheduled surgery
2. Initiate oseltamivir 75 mg once daily as soon as possible after exposure 1
3. Monitor daily for symptoms (fever >100°F, cough, myalgia, malaise) 4
4. If symptoms develop: Switch to treatment dose (75 mg twice daily), notify transplant team immediately, and postpone surgery 1
5. If asymptomatic: Continue prophylaxis through surgery or for 10 days post-exposure, whichever is appropriate based on transplant team guidance 7
6. Consider pre-operative influenza testing if surgery cannot be delayed and exposure was recent 4