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. 2021 Mar 18:12:645718.
doi: 10.3389/fimmu.2021.645718. eCollection 2021.

Herpes Zoster in Solid Organ Transplantation: Incidence and Risk Factors

Marcia M L Kho  1   2 , Stefan Roest  2   3 , Dominique M Bovée  1   2 , Herold J Metselaar  2   4 , Rogier A S Hoek  2   5 , Annemiek A van der Eijk  6 , Olivier C Manintveld  2   3 , Joke I Roodnat  1   2 , Nicole M van Besouw  1   2
Affiliations

Herpes Zoster in Solid Organ Transplantation: Incidence and Risk Factors

Marcia M L Kho et al. Front Immunol. .

Abstract

Background: Studies on herpes zoster (HZ) incidence in solid organ transplant (SOT) recipients report widely varying numbers. We investigated HZ incidence, severity, and risk factors in recipients of four different SOTs, with a follow-up time of 6-14 years.

Methods: Records of 1,033 transplant recipients after first heart (HTx: n = 211), lung (LuTx: n = 121), liver (LiTx: n = 258) and kidney (KTx: n = 443) transplantation between 2000 and 2014 were analyzed for VZV-PCR, clinical signs of HZ, and complications.

Results: HZ was diagnosed in 108 of 1,033 patients (10.5%): 36 HTx, 17 LuTx, 15 LiTx, and 40 KTx recipients. Overall HZ incidence rate after HTx (30.7 cases/1,000 person-years (PY)), LuTx (38.8 cases/1,000 PY), LiTx (22.7 cases/1,000 PY) and KTx (14.5 cases/1,000 PY) was significantly higher than in the general 50-70 year population. Multivariable analysis demonstrated age ≥50 years at transplantation (p = 0.038, RR 1.536), type of organ transplant (overall p = 0.002; LuTx p = 0.393; RR 1.314; LiTx p = 0.011, RR 0.444; KTx p = 0.034, RR 0.575), CMV prophylaxis (p = 0.043, RR 0.631) and type of anti-rejection therapy (overall p = 0.020; methylprednisolone p = 0.008, RR 0.475; r-ATG p = 0.64, RR1.194) as significant risk factors. Complications occurred in 33 of 108 (31%) patients (39% of HTx, 47% of LuTx, 20% of LiTx, 20% of KTx): post-herpetic neuralgia, disseminated disease, and cranial nerve involvement.

Conclusion: HZ incidence and severity in SOT recipients are most pronounced after heart and lung transplantation, in older patients, and when CMV prophylaxis is lacking.

Keywords: herpes zoster; incidence; organ transplantation; risk factors; varicella zoster virus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Adult recipients of a first solid organ transplant with a minimum follow-up of 1 month and complete medical charts were included in the analysis. tx= transplantation.
Figure 2
Figure 2
Herpes zoster free survival after solid organ transplantation, censored for death and graft failure. Cox proportional hazards, multivariable analysis. First episodes of herpes zoster were counted as event. Herpes zoster incidence is significantly higher in heart recipients compared to liver (p = 0.011) and kidney (p = 0.034) transplant recipients. For each organ type, the number of patients at risk at each year after transplantation is described below the graph.
See this image and copyright information in PMC

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