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.
Highlights
Herpes zoster (HZ) is a significant cause of morbidity and complications in adult renal transplant recipients
Our results revealed an overall incidence rate of HZ of 20.6 cases per 1000 person-years, while age ≥ 60 years at time of transplant, positive pretransplant history of varicella- zoster related disease and administration of anti- rejection treatment were identified as significant risk factors for the development of shingles; most HZ cases were managed as outpatients, there was no disseminated disease, a high proportion of individuals suffered post-herpetic neuralgia
As shown before [15], when we used the Kaplan-Meier method to evaluate the probability of developing HZ in the post transplant period, we found that this probability, very low (0.7 %) in the first six months, increased rapidly over time, reaching 10.7 % after five years
Summary
Herpes zoster (HZ) is a significant cause of morbidity and complications in adult renal transplant recipients. Complications and risk factors for the development of HZ after renal transplantation in a setting using universal antiviral prophylaxis. Herpes zoster (HZ) represents the reactivation of the varicella zoster virus (VZV), which establishes lifelong latency in cranial- nerve or dorsal-root ganglia after the primary infection that had caused chickenpox [1, 2]. 20-40 % of the transplant recipients will develop post-herpetic neuralgia (PHN) as a secondary complication, significantly greater than the rate in immunocompetent populations [13]. Risk factors for the development of HZ in SOT have not been well defined due to the lack of large prospective trials
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
