title: Herpes zoster incidence in a multicenter cohort of solid organ transplant recipients.
abstract: BACKGROUND
  Immunosuppressed patients are at increased risk for herpes zoster (HZ), but incidence in solid organ transplant (SOT) recipients has varied in multiple studies. To assess incidence of HZ, we examined patients who underwent SOT and received follow-up care within the large multicenter US Department of Veteran's Affairs healthcare system.
  
  
  METHODS
  Incident cases of HZ were determined using ICD-9 coding from administrative databases. A multivariable Cox proportional hazards model, adjusted for a priori risk factors, was used to assess demographic factors associated with development of HZ.
  
  
  RESULTS
  Among the 1077 eligible SOT recipients, the cohort-specific incidence rate of HZ was 22.2 per 1000 patient-years (95% confidence interval [CI], 18.1-27.4). African Americans (37.6 per 1000 [95% CI, 25.0-56.6]) and heart transplants recipients (40.0 per 1000 [95% CI, 23.2-68.9]) had the highest incidence of HZ. Patients transplanted between 2005 and 2007 had the lowest incidence (15.3 per 1000 [95% CI, 8.2-28.3]). In a multivariable model, African Americans (hazard ratio [HR] 1.88; 95% CI: 1.12, 3.17) and older transplant recipients (HR 1.13; 95% CI: 1.01, 1.27 [per 5-year increment]) had increased relative hazards of HZ.
  
  
  CONCLUSIONS
  These data demonstrate that HZ is a common infectious complication following SOT. Future studies focused on HZ prevention are needed in this high-risk population.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington 98109, USA. spergam@fhcrc.org
authors.forename: S A
authors.initials: SA
authors.lastname: Pergam
authors.forename: C W
authors.initials: CW
authors.lastname: Forsberg
authors.forename: M J
authors.initials: MJ
authors.lastname: Boeckh
authors.forename: C
authors.initials: C
authors.lastname: Maynard
authors.forename: A P
authors.initials: AP
authors.lastname: Limaye
authors.forename: A
authors.initials: A
authors.lastname: Wald
authors.forename: N L
authors.initials: NL
authors.lastname: Smith
authors.forename: B A
authors.initials: BA
authors.lastname: Young
mesh_terms: D001741:Black or African American; D015331:Cohort Studies; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects; D006562:Herpes Zoster / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000821:virology; D014645:Herpesvirus 3, Human; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012307:Risk Factors