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All SOTR older than 16?years, diagnosed with influenza A(H1N1), and hospitalized at the participating centres from June 2009 to January 2010, were included. A confirmed case was defined in the presence of influenza-like illness with laboratory-confirmed 2009 pandemic influenza A(H1N1) virus infection. The study was approved by the coordinator local ethics committee and informed consents were obtained from all subjects. In cases of respiratory symptoms, SOTR were advised to seek care at the hospital. Thereafter, an investigator evaluated and followed them until cure or death in the case of influenza diagnosis, and clinical data were recorded in a standardized protocol. Data were collected on demographic characteristics, co-morbidities, body mass index (BMI), type of transplant and immunosuppressive therapy, previous vaccination, clinical signs and symptoms, biochemical [http://www.selleckchem.com/products/obeticholic-acid.html see more] analysis, chest X-ray findings, antiviral and antibacterial therapy, concomitant and/or secondary infection, and outcomes, including mortality. Pandemic influenza A(H1N1) was confirmed with RT-PCR (Inf A/H1N1 Detection, Roche, Basel, Switzerland), in naspopharyngeal smears or aspirates. Blood cultures, standard studies for bacterial and fungi of respiratory samples (sputum, bronchial aspirates, bronchoalveolar lavage, protected specimen brush and transbronchial biopsy), and urinary antigen tests for Streptococcus pneumoniae and Legionella pneumophila serogroup 1 were performed. Sputum samples were processed if they contained >25 polymorphonuclears and [http://en.wikipedia.org/wiki/CDK9 CDK9] cells per high-power field. Viral co-infection was investigated in nasopharyngeal samples using a PCR multiplex RV 12 ACE detection seeplex kit (Seegene Inc., Seul, Corea) including metapneumovirus, adenovirus, coronavirus 229E/NL63 and OC43/HKU1, parainfluenza virus 1/2/3, rhinovirus A/B, respiratory syncytial viruses (RSV) A/B, and influenza virus A/B. Obesity was defined as a BMI ��30. Hospital-acquired influenza was considered when symptoms began more than 7?days after admission. Pneumonia was defined by the presence of clinical symptoms (fever, dyspnoea, cough and/or expectoration) [http://www.selleckchem.com/products/s-gsk1349572.html Dolutegravir] and a new pulmonary infiltrate in the chest X-ray for which other non-infectious causes were excluded. Severity of pneumonia was assessed by the PSI and CURB-65 scores [18,19]. Non-viral co-infection was considered if bacteria or fungi were isolated from blood or respiratory samples, or with positive urinary antigen detection tests of S.?pneumoniae or L.?pneumophila. Severe infections were defined as cases that were admitted to ICU, developed graft rejection or died. A descriptive analysis was performed. Continuous variables are expressed as median and range. All proportions were calculated as percentages of the patients with available data. The chi-square or Fisher��s exact tests were used for categorical variables and the Student-t, Mann�CWhitney and Wilcoxon tests for continuous variables, when appropriate.