Disseminated varicella infection in pediatric renal transplant recipients treated with mycophenolate mofetil.
BACKGROUND
Mycophenolate mofetil (MMF) is a new immune suppressive agent, effective in the prevention of acute rejection after renal transplantation.


METHODS
The study was a retrospective review of records of pediatric renal transplant recipients from 1985 to the present.


RESULTS
Since October 1995, the immune suppression protocol for pediatric renal transplant recipients at Mayo Eugenio Litta Children's Hospital has included MMF, prednisone, and cyclosporine A. During that time, 19 children and adolescents have received renal allografts, 17 of whom were seropositive for varicella antibody before transplantation, while 2 were seronegative. Varicella infection occurred in 3 of 19 patients (15.8%), all 3 of whom had serologically documented immunity to varicella virus before transplantation. All episodes occurred within 12 months of transplantation. All had generalized vesicular lesions without dermatomal distribution. None of the patients developed fever, respiratory, mucocutaneous, or central nervous system manifestations. All were managed with oral acyclovir, and had an uncomplicated recovery without neuralgia. By contrast, of 74 consecutive patients transplanted before use of MMF, only 1 patient (1.4%) had varicella infection after transplantation (P=0.026).


CONCLUSIONS
The enhanced immunosuppression achieved with MMF appears to be associated with increased susceptibility to varicella infection.
Rothwell
W S
WS
Mayo Eugenio Litta Children's Hospital and the Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Gloor
J M
JM
Morgenstern
B Z
BZ
Milliner
D S
DS
D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D002644:Chickenpox / Q000209:etiology / Q000276:immunology*; D002675:Child, Preschool; D005260:Female; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors
D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid