Herpes zoster after lung transplantation boosts varicella zoster virus-specific adaptive immune responses.
Varicella zoster virus (VZV)-specific memory T cells are significantly lower in transplant recipients than in controls. In addition, VZV-specific immunoglobulin G titers are significantly lower after than before transplantation. Data on the incidence and timing of herpes zoster (HZ) after lung transplantation are limited. This study had two aims: first, we investigated the incidence and severity of HZ after lung transplantation; second, we determined the systemic VZV-specific T-cell and B-cell memory responses before and after HZ.



The records of 119 patients who underwent transplantation were analyzed for post-transplant HZ. The VZV-specific B-cell and T-cell memory responses of 5 patients before and after HZ were compared with 5 patients without HZ by enzyme-linked immunospot assay and flow cytometry, respectively.



HZ was clinically diagnosed and confirmed by polymerase chain reaction on blister fluids and/or plasma in 17 transplant recipients. Uncomplicated cutaneous HZ was present in 12 patients, and 5 patients had disseminated HZ, of whom 1 died. The incidence of HZ after transplantation (38.2 cases/1,000 patient-years) was significantly higher than the age-matched healthy population (7-8 cases/1,000 patient-years). The frequency of VZV-specific immunoglobulin G-producing B cells (p = 0.06) and the percentage of VZV-specific CD4 and CD8 memory T cells increased after HZ to higher frequencies than in patients without HZ (p = 0.03). This was mainly attributed to VZV-reactive effector memory CD4 T cells (p = 0.02) and central memory (p = 0.02) and effector memory (p = 0.03) CD8 T cells.



Lung transplant recipients are highly prone to develop HZ with severe complications. Despite deep immunosuppression, HZ boosted their systemic VZV-specific B-cell and T-cell memory responses.
Department of Internal Medicine-Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands. Electronic address: n.vanbesouw@erasmusmc.nl.
Nicole M
NM
van Besouw
Department of Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Peter Th W
PT
van Hal
Department of Internal Medicine-Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Joke M
JM
Zuijderwijk
Department of Internal Medicine-Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Ronella
R
de Kuiper
Department of Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Rogier A S
RA
Hoek
Department of Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Jan J
JJ
van Weezel
Department of Viroscience, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Annemiek A
AA
van der Eijk
Department of Viroscience, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Georges M G M
GM
Verjans
Department of Internal Medicine-Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Willem
W
Weimar
D056704:Adaptive Immunity; D058501:Enzyme-Linked Immunospot Assay; D006562:Herpes Zoster; D014645:Herpesvirus 3, Human; D006801:Humans; D016040:Lung Transplantation
B cells; ELISpot; IFN-γ; VZV; memory cells