Klinisch II - P20 - High incidence of herpes zoster after kidney, liver, heart and lung transplantation

N.M. van Besouw, S. Roest, D.M. Bovée, H.J. Metselaar, R.A.S. Hoek, J.J. van Weezel, A.A. van der Eijk, W. Weimar, O.C. Manintveld, M.M.L. Kho

Chair(s): prof. dr. Herold Metselaar, MDL-arts, Erasmus MC Rotterdam

Thursday 10 march 2016

12:30 - 13:00h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

Background:
Primary varicella zoster virus (VZV) infection causes varicella and lifelong latent infection in neural ganglia from which it may reactivate leading to herpes zoster (HZ). Immunocompromised transplant recipients are at risk to develop HZ and severe clinical complications. Therefore, we investigated the incidence of HZ after the first organ transplant and analysed the severity of HZ.

Methods:
The records of 958 transplant recipients after the first kidney (KTx: n=420), first liver (LTx: n=224), heart (HTx: n=195) and lung (LuTx: n=119) transplantation were analysed for VZV-PCR DNA and clinical signs of HZ.

Results:
HZ infection was clinically diagnosed and confirmed by PCR in 107 patients: 38 KTx, 16 LTx, 36 HTx and 17 LuTx recipients. 9/38 patients post-KTx had complicated HZ: 6 had disseminated HZ (≥3 dermatomes) of whom one died due to encephalitis/meningitis 2 weeks later and 3 had cranial nerve involvement. 2/16 patients post-LTx had disseminated HZ. 14/36 patients had complicated HZ post-HTx: 2 had systemic dissemination, 5 had cranial nerve involvement and 7 had post herpetic neuralgia (PHN). 8/17 patients had complicated HZ post LuTx: 3 had PHN and in one patient the cranial nerves were involved and she died six days later. The overall incidence rate of HZ post-KTx (14.4 cases/1000 PY), LTx (24.5 cases/1000 PY), HTx (30.8 cases/1000 PY) and LuTx (38.2 cases/1000 PY) was significantly higher than in the general population of 50-70 years of age (7-8 cases/1000 PY).

Conclusion:
HZ is a frequent complication after kidney, liver, heart and lung transplantation. Boosting the VZV immune response by prophylactic VZV vaccination pre-transplantation may limit the incidence and severity of HZ post-transplantation.