Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis

Abstract

BackgroundHerpes zoster (HZ) is a significant cause of morbidity and complications in adult renal transplant recipients. We determined the incidence, complications and risk factors for the development of HZ after renal transplantation in a setting using universal antiviral prophylaxis.MethodsThe medical files of all adult renal transplants, performed between 2004 and 2008, were retrospectively reviewed to assess the clinical characteristics and risk factors of HZ. Incident cases of HZ were determined and the probability of developing post-transplant HZ for all subjects was calculated using the Kaplan Meier method. A multivariable Cox proportional hazards model was applied to assess the risk factors associated with the development of HZ.ResultsA total of 450 patients were eligible with a median follow up of 38 months. Twenty nine subjects (6.4 %) developed HZ, the median time to onset was 18 months, only three of them (10.3 %) required hospitalization, and none developed disseminated or visceral disease and death directly attributed to zoster. However, high rates of post-herpetic neuralgia (48.7 %) were observed. Overall incidence was calculated at 20.6 cases per 1000 patient-years of follow-up. Following multivariate analysis, increased age ≥ 60 years old, positive pre-transplant history of varicella related disease and administration of rejection treatment conferred an increased risk of 4.00-fold (CI: 1.79- 8.92), 16.00-fold (CI: 4.62- 55.52), and 5.57-fold (CI: 1.56- 19.84) respectively, for the development of post-transplant zoster.ConclusionsHZ remains a common complication after renal transplantation in adults under current immunosuppession protocols and universal antiviral prophylaxis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1038-1) contains supplementary material, which is available to authorized users.

Preventive Strategies Against Cytomegalovirus and Incidence of α-Herpesvirus Infections in Solid Organ Transplant Recipients: A Nationwide Cohort Study

“…Although higher rates of infection have been previously reported in lung transplant recipients (8,(21)(22)(23)(24), our results can be explained by a longer duration of antiviral prophylaxis used in these patients compared with other organ transplants. Of note, the antiviral agents approved for the prevention and treatment of herpesvirus infections act at the same step of virus replication, inhibiting the viral DNA polymerase.…”

“…We found a surprising lower incidence of HSV and VZV infections in lung transplant recipients compared with other types of transplant. Although higher rates of infection have been previously reported in lung transplant recipients (8,(21)(22)(23)(24), our results can be explained by a longer duration of antiviral prophylaxis used in these patients compared with other organ transplants. Finally, we found that both acyclovir/ valacyclovir and ganciclovir/valganciclovir seemed equally effective for the prevention of a-herpesvirus infectionan expected result but not extensively reported in the literature.…”

Reactivation of Herpesvirus in Patients With Hepatitis C Treated With Direct-Acting Antiviral Agents

“…4 Herpes zoster (HZ) is the result of reactivation of a previous VZV infection, remaining latent in cranial nerves and dorsal root ganglia and manifesting in periods when there is a direct or indirect down-regulation of the immune system. 3,5,6 However, balance between latency and reactivation of VZV seems to be a complex process in which a precise understanding of the activated pathways by clinical factors is lacking. 3 Several studies have shown that VZV reactivation, most commonly as cutaneous herpes zoster, can be observed in transplanted patients receiving immunosuppressive treatment.…”

“…Those patients receiving a more intensive immunosuppression (typically heart or lung recipients) are at higher risk, particularly with age older than 60 years. [5][6][7] Cases 1, 2, and 3 were LT patients, and 2 of these patients were older than age 65, and therefore they would share some of the earlier-mentioned risk factors (Table 1). Nevertheless, all of the reactivations that occurred in our patients happened during HCV treatment.…”

Barriers to vaccination in renal transplant recipients

“…21 When compared to immunocompetent patients, immunosuppressed patients often have more severe cases of infection, which may lead to life-threatening complications. 20,22,23 Moreover, immunocompromised patients are also burdened with a higher prevalence of infection sequelae such as postherpetic neuralgia, a consequence of infection shown to be prevented or diminished after vaccination. 24 However, no data support the assertion that pretransplant HZV administration will reduce the number of cases of varicella zoster virus reactivation or the severity of illness or prevention of disease sequelae in the RTR population.…”