Bootcongres

Introduction: After primary infection varicella zoster virus (VZV) establishes latency in sensory neuron ganglia. Upon reactivation it causes herpes zoster (HZ), typically a self-limiting condition characterized by a painful unilateral vesicular rash, localized in the sensory region of affected ganglia. In the general population HZ incidence increases with age from 1-4 cases/1000 person years (PY) in people aged <50 years to 7-8 cases/1000 PY in the age range of 50-70 years to 10 cases/1000 PY in elderly of >80 years. Incidence of HZ also increases in immune compromised persons. However, incidence and severity of HZ after renal transplantation is unknown in the Netherlands. Patients and methods: Renal transplant recipients transplanted between 2003-2008 at our transplant center were studied. We investigated clinical presentation, complications and clinical outcome of HZ. Data were collected from medical charts, by mail and telephone contact. Results: 754 patients received a renal transplant. We collected data on occurrence of HZ of 522 patients (317 men, 205 women). Data of 232 patients were unobtainable due to death or loss to follow-up. 111 (21.3%) patients had in total 120 episodes of HZ. 39 (7.5%) had HZ before dialysis, 11 (2.1%) during dialysis and 66 (12.6%) after transplantation. Of the patients with HZ post transplantation, median age at presentation was 54 years (range: 12-78). Median time to onset of HZ was 29 months (range: 1-225). Overall calculated incidence of HZ was 17.2 cases/1000 PY. In patients <50 years 12.5 cases/1000 PY and in patients ≥50 years 22.7 cases/1000 PY. Eight patients had complications, such as bacterial superinfection, ophthalmic or otic involvement. Three of them had systemic dissemination and all three died. Duration of blisters was significantly longer under immune suppression than without. Conclusion: Incidence of HZ in renal transplant recipients is significantly higher than in the healthy population. Prophylactic VZV vaccination before transplantation might reduce HZ associated morbidity after transplantation.