title: Incidence and risk factors of herpes zoster among adult renal transplant recipients receiving universal antiviral prophylaxis.
abstract: BACKGROUND
  Herpes zoster (HZ) is a significant cause of morbidity and complications in adult renal transplant recipients. We determined the incidence, complications and risk factors for the development of HZ after renal transplantation in a setting using universal antiviral prophylaxis.
  
  
  METHODS
  The medical files of all adult renal transplants, performed between 2004 and 2008, were retrospectively reviewed to assess the clinical characteristics and risk factors of HZ. Incident cases of HZ were determined and the probability of developing post-transplant HZ for all subjects was calculated using the Kaplan Meier method. A multivariable Cox proportional hazards model was applied to assess the risk factors associated with the development of HZ.
  
  
  RESULTS
  A total of 450 patients were eligible with a median follow up of 38 months. Twenty nine subjects (6.4%) developed HZ, the median time to onset was 18 months, only three of them (10.3%) required hospitalization, and none developed disseminated or visceral disease and death directly attributed to zoster. However, high rates of post-herpetic neuralgia (48.7%) were observed. Overall incidence was calculated at 20.6 cases per 1000 patient-years of follow-up. Following multivariate analysis, increased age ≥ 60 years old, positive pre-transplant history of varicella related disease and administration of rejection treatment conferred an increased risk of 4.00-fold (CI: 1.79-8.92), 16.00-fold (CI: 4.62-55.52), and 5.57-fold (CI: 1.56-19.84) respectively, for the development of post-transplant zoster.
  
  
  CONCLUSIONS
  HZ remains a common complication after renal transplantation in adults under current immunosuppession protocols and universal antiviral prophylaxis.
authors.affiliation: Paediatric Research Laboratory, National and Kapodistrian University of Athens, Faculty of Nursing, Athens, Greece. idpavlop@yahoo.gr.
authors.forename: Ioanna D
authors.initials: ID
authors.lastname: Pavlopoulou
authors.affiliation: Athens University of Economics and Business, Athens, Greece. spoulopo@gmail.com.
authors.forename: Stavroula
authors.initials: S
authors.lastname: Poulopoulou
authors.affiliation: Renal Transplant Unit, "Laiko" General Hospital, National and Kapodistrian University, Faculty of Medicine, Athens, Greece. xmelexopoulou@yahoo.gr.
authors.forename: Christina
authors.initials: C
authors.lastname: Melexopoulou
authors.affiliation: Postgraduate Program, National and Kapodistrian University of Athens, Faculty of Nursing, Athens, Greece. joanna_papazaxaria@yahoo.gr.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Papazaharia
authors.affiliation: Renal Transplant Unit, "Laiko" General Hospital, National and Kapodistrian University, Faculty of Medicine, Athens, Greece. gzavvos.md@gmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Zavos
authors.affiliation: Renal Transplant Unit, "Laiko" General Hospital, National and Kapodistrian University, Faculty of Medicine, Athens, Greece. laikneph@laiko.gr.
authors.forename: Ioannis N
authors.initials: IN
authors.lastname: Boletis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000706:statistics & numerical data; D002644:Chickenpox / Q000150:complications / Q000453:epidemiology; D005260:Female; D006562:Herpes Zoster / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients / Q000706:statistics & numerical data; D014777:Virus Diseases / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000998:Antiviral Agents