Varicella Infection in Adult Renal Allograft Recipients: Experience at One Center

Rodríguez-Moreno, Antolina; Fructuoso, Ana Sánchez; Calvo, N.; Ridao, N.; Conesa, J.; Marqués, María; Prats, D; Barrientos, Alberto

doi:10.1016/j.transproceed.2006.08.060

Cited by 40 publications

(36 citation statements)

References 6 publications

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“…Only 4 patients experienced disease a long time after transplantation, thus prolonging the median time of onset (2.13 years). Previous studies reported the onset of VZV infection after solid organ transplantation to be between 2 and 92 months [3,5,18] . Switch from AZA to MMF resulted in more intensive immunosuppression and subsequently in development of VZV infection in 2 of our patients (up to 228 months after transplantation).…”

Section: Discussionmentioning

confidence: 99%

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Varicella Zoster Infection in Renal Transplant Recipients: Prevalence, Complications and Outcome

Mustapić

Bašić‐Jukić²,

Kes³

et al. 2011

Kidney Blood Press Res

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Varicella zoster virus (VZV) is an important pathogen after renal transplantation. In the present study, we examined the prevalence, clinical presentation and outcome of VZV infections in renal transplant recipients. Charts and medical records of adult renal allotransplant recipients were investigated to find patients with VZV infection. From December 1972 until July 2010, 1,139 patients received kidney allograft at our institution. VZV infection was diagnosed in 40 patients (3.51%). 28 patients (70%) had intensified immunosuppression prior to VZV infection occurrence. Median time of onset was 2.13 years after transplantation (range 9 days to 19.2 years). 35 patients developed VZV during the first post-transplant year (median 0.61 years). Four patients developed VZV infection more than 12 years after transplantation. 33 patients (82.5%) had dermatomal distribution, 5 (12.5%) disseminated herpes zoster (HZ), and 2 patients (5%) who were VZV IgG-negative before transplantation, developed chickenpox. Immunosuppression was reduced and patients received acyclovir. Cutaneous scarring was recorded in 7 cases (17.5%). Two patients developed post-herpetic neuralgia, which was accompanied by scarring and skin depigmentation in 1 of them. Five patients (12.5%) experienced relapse of HZ. Timely initiation of therapy may prevent development of complications and the visceral form of disease. Based on our experience with development of chickenpox, we suggest active immunization for all seronegative patients before organ transplantation.

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Section: Discussionmentioning

confidence: 99%

“…Varicella zoster virus (VZV) is an important pathogen in organ transplant recipients [2,3] . VZV infection causes two clinically different forms of disease: primary disease (varicella or chickenpox) is characterized by ve-…”

mentioning

confidence: 99%

Varicella Zoster Infection in Renal Transplant Recipients: Prevalence, Complications and Outcome

Mustapić

Bašić‐Jukić²,

Kes³

et al. 2011

Kidney Blood Press Res

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“…Typically, post‐transplant VZV infection occurs within the first year after transplantation, with a median onset post‐transplant of 9 months . However, disseminated VZV is often delayed, with median onset of 1.8‐4.0 years following transplantation . Although VZV infection can occur at any stage post‐transplantation, augmented immunosuppression for either increased risk or treatment of organ rejection is a recognized risk factor, which was not present in this case.…”

Section: Discussionmentioning

confidence: 82%

“…The correct diagnosis was delayed despite being hospitalized to investigate and manage her severe pain, contributed by the initial absence of a rash and the atypical combination of syndromes (hepatitis and pancreatitis). SOT recipients have a much greater risk of disseminated VZV, occurring in up to 40% of the patients and it is associated with high mortality rates of between 12.5%‐34% despite treatment . Visceral VZV infection is associated with a triad of hyponatremia, right upper–quadrant pain and transaminitis …”

Section: Discussionmentioning

confidence: 99%

Fatal disseminated visceral varicella zoster virus infection in a renal transplant recipient

Loftus

Yong

Wilson

et al. 2019

Transplant Infectious Dis

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We report a case of fatal disseminated varicella zoster virus (VZV) with delayed–onset rash in a 66‐year‐old female more than 2 years following uncomplicated deceased donor renal transplantation. Whilst on a stable regimen of maintenance immunosuppression, the patient presented with chest and abdominal pain with concomitant hepatitis and pancreatitis. After pursuing multiple other potential causes of her symptoms, the correct diagnosis of VZV was only suspected after the development of a widespread vesicular rash—11 days after her initial symptoms. Despite antiviral therapy and inotropic support in the intensive care unit, the patient died. Simultaneous VZV hepatitis and pancreatitis in solid organ transplant recipients is uncommon. The new inactivated VZV vaccines have the potential to prevent post‐transplant infections, with promising early clinical data on safety and efficacy in renal transplant recipients. VZV is an important preventable infection that should be considered in immunocompromised patients, even in the absence of rash.

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“…Two children died of complications of VZV infection, including one child who received VZIG on the day of exposure to varicella. [59]. Treatment consisted of reduced immunosuppression and aciclovir, and in six patients, a VZIG dose.…”

Section: Renal Transplant Recipientsmentioning

confidence: 99%

Aciclovir and Varicella-zoster-immunoglobulin in solid-organ transplant recipients

2010

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Clear recommendations for the management of acute varicella-zoster virus (VZV) infections for cases of significant exposure and the use of prophylactic drugs after solid-organ transplantation are missing due to the lack of evidence by prospective studies. Heterogeneity in patient groups, patient numbers, age groups, immunosuppressive regimens, timing, and dosage of aciclovir and/or varicella-zoster immunoglobulin (VZIG), pre-transplant vaccination or VZV wild-type infection and inconsistency of data make comparability of different studies impossible. Although the benefit of aciclovir and/or VZIG is uncertain in immunosuppressed children, prospective controlled double-blind studies are not feasible for ethical considerations as fatal cases with disseminating varicella disease are well known in these patient groups despite the use of aciclovir and/or VZIG, whereas severe side-effects of these drugs are rare. However, a reporting bias is likely as mainly severe or fatal cases might have been predominantly published or cases of successfully used aciclovir and/or VZIG in mild cases or in cases of breakthrough infections after vaccination. As neither VZIG prophylaxis nor treatment with intravenous aciclovir offers complete protection against severe VZV infection to immunosuppressed pediatric solid-organ transplant recipients, high priority should be given to vaccination against VZV prior to transplantation, and, most importantly, in their close contact persons. Clinical observations suggest that only assessment of humoral immunity together with cellular immunity may allow predication about protection in exposed patients.

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Varicella Infection in Adult Renal Allograft Recipients: Experience at One Center

Cited by 40 publications

References 6 publications

Varicella Zoster Infection in Renal Transplant Recipients: Prevalence, Complications and Outcome

Varicella Zoster Infection in Renal Transplant Recipients: Prevalence, Complications and Outcome

Fatal disseminated visceral varicella zoster virus infection in a renal transplant recipient

Aciclovir and Varicella-zoster-immunoglobulin in solid-organ transplant recipients

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