Incidence and clinical characteristics of herpes zoster after lung transplantation.
BACKGROUND
Solid-organ transplant recipients are at high risk for the development of herpes zoster. Epidemiologic data in lung transplant recipients are lacking. We determined the incidence and clinical characteristics of herpes zoster, and the risk factors for developing herpes zoster, after lung transplantation.


METHODS
We retrospectively reviewed all adult (>18 years old) lung transplants performed at our institution between January 2001 and December 2005. Clinical characteristics of herpes zoster and potential risk factors associated with herpes zoster were assessed.


RESULTS
Two hundred thirty-nine lung transplant recipients were included in the analysis. Median time of follow-up was 722 days (range 18 to 1,943 days). Thirty-five episodes of herpes zoster occurred in 29 patients, with a calculated incidence of 55.1 cases per 1,000 person-years of follow-up. The cumulative probability of herpes zoster was 5.8% at 1 year, 18.1% at 3 years and 20.2% at 5 years post-transplant. Only 2 of the 35 (5.7%) patients had disseminated cutaneous infection and none had visceral involvement. Recurrence of herpes zoster was seen in 13.8% of patients. Post-herpetic neuralgia was detected in 20% of cases. Anti-viral prophylaxis, primarily for cytomegalovirus (CMV), was protective against herpes zoster. No significant epidemiologic risk factors associated with herpes zoster could be identified.


CONCLUSIONS
Herpes zoster is a common complication after lung transplantation with a peak incidence at between 1 and 4 years post-transplant. Preventive strategies would be beneficial for this population.
Manuel
Oriol
O
Department of Transplant Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada. o.manuel@provlab.ab.ca
Kumar
Deepali
D
Singer
Lianne G
LG
Cobos
Isabel
I
Humar
Atul
A
D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006562:Herpes Zoster / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D053061:Herpes Zoster Vaccine / Q000627:therapeutic use; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors
D000914:Antibodies, Viral; D000998:Antiviral Agents; D053061:Herpes Zoster Vaccine; D007166:Immunosuppressive Agents