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Varicella zoster virus in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
Author(s) -
Pergam Steven A.,
Limaye Ajit P.
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13622
Subject(s) - medicine , immunosuppression , varicella zoster virus , organ transplantation , transplantation , chickenpox , complication , vaccination , intensive care medicine , virus , immunology , pediatrics , surgery
These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the diagnosis, prevention, and management of varicella zoster virus (VZV) in the pre‐ and post‐transplant period. Primary varicella is an uncommon complication post‐solid‐organ transplant (SOT), except among pediatric transplant patients and those seronegative for VZV. As the majority of SOT recipients are seropositive for VZV, herpes zoster (HZ) occurs frequently following SOT, particularly among recipients who are older (≥65 years of age) and those receiving more intensive immunosuppression. Transplant providers should aware of the increased risk for HZ‐related complications such as dissemination, organ‐specific involvement, and post‐herpetic neuralgia. Treatment for localized zoster is primarily given as oral regimens, but those with more complicated presentations or those at risk for dissemination should be treated initially with IV therapy. Available antiviral prophylaxis regimens and vaccination strategies for varicella and HZ among these immunosuppressed patients remain a mainstay for prevention in the pre‐and post‐transplant periods. Finally, we discuss important approaches to addressing post‐exposure prophylaxis and infection control practices for those SOT patients with documented VZV infections.