Abstract
Herpes zoster (HZ) results from reactivation of latent varicella zoster virus (VZV) presenting as a dermatomal rash. Diminished cellular immunity to VZV increases HZ risk and incidence in solid organ transplant (SOT) is higher than the general population. Immunogenicity and safety of the inactivated varicella vaccine (RZV, Shingrix) has been demonstrated in renal transplant (KT) but data in heart transplant (HT) are lacking. Retrospective single center observational study of 65 HT patients vaccinated with RZV between Sept 2018 and Jul 2019. RZV 0.5 mL was administered IM in two doses 2 to 6 months apart. Descriptive statistics were used for data analysis. Mean age was 66 +/- 12.7 y, 65% (n=41) male, and 75% (n=49) Caucasian. Mean time from HT to RZV was 11.4 +/- 6.6 y. The majority were HT alone, 7.7% (n=5) heart-kidney, and 4.6% (n=3) heart retransplant. Most (95%, n=62) were on calcineurin inhibitors (CNI) for immunosuppression, 54% (n=35) on antiproliferatives (mycophenolate mofetil (MMF)), 46% (n=30) on steroids, and 20% (n=13) on mTOR inhibitors. At the time of RZV, mean tacrolimus trough (t): 6.8 +/- 2.3 ng/mL, everolimus t: 6.5 +/- 1 ng/mL, sirolimus t: 7.5 +/- 2.9 ng/mL, prednisone dose: 4.2 +/- 1.3 mg, and MMF dose: 977.9 +/- 462 mg. Vaccination was well tolerated in all patients. 36 patients (55%) received both doses of RZV 4 +/- 1.4 mo apart. Adverse events (AE) occurred in 34% (n=22) after the first dose. The majority (83%, n=19) were injection site reactions (arm soreness, swelling), 1 with vomiting, 1 with fever, 1 with headache, 2 with fatigue. One developed HZ 2 months after vaccination and was a 65 yo F with heart retransplant, KT, and stem-cell transplant, received the vaccine 3.3 y from the second HT, and on tacrolimus, MMF, and prednisone. There was no allograft rejection following immunization. 16 patients are awaiting the second dose. After the second dose, 36% (n=13), had AE due to 13 injection site reactions and 1 fever. 12 patients did not receive the second dose due to cost (n=1), unavailability of the vaccine (n=3), treatment for PTLD (n=1), viral syndrome (n=4), development of HZ (n=1), and patient refusal (n=2). HT patients who received RZV tolerated it well with the most common AE being injection site soreness. Only one patient (1.5%) developed HZ 2 months following the vaccination. There was no evidence of increased allograft rejection.
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