Open AccessHerpes zoster in kidney transplant recipients: protective effect of anti‐cytomegalovirus prophylaxis and natural killer cell count. A single‐center cohort study
Author(s) -
FernándezRuiz Mario,
Origüen Julia,
Lora David,
LópezMedrano Francisco,
González Esther,
Polanco Natalia,
San Juan Rafael,
RuizMerlo Tamara,
Parra Patricia,
Andrés Amado,
Aguado José María
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13076
Subject(s) - medicine , hazard ratio , immunosuppression , cytomegalovirus , incidence (geometry) , ganciclovir , transplantation , cohort , immunology , kidney transplantation , postherpetic neuralgia , gastroenterology , human cytomegalovirus , surgery , confidence interval , viral disease , herpesviridae , virus , anesthesia , physics , optics , neuropathic pain
Summary Despite its impact on quality of life and potential for complications, specific risk and protective factors for herpes zoster ( HZ ) after kidney transplantation ( KT ) remain to be clarified. We included 444 patients undergoing KT between November 2008 and March 2013. Peripheral blood lymphocyte subpopulations were measured at baseline and months 1 and 6. The risk factors for early (first post‐transplant year) and late HZ (years 1–5) were separately assessed. We observed 35 episodes of post‐transplant HZ after a median follow‐up of 48.3 months (incidence rate: 0.057 per 1000 transplant‐days). Median interval from transplantation was 18.3 months. Six patients (17.1%) developed disseminated infection. Postherpetic neuralgia occurred in 10 cases (28.6%). The receipt of anti‐cytomegalovirus ( CMV ) prophylaxis with (val)ganciclovir decreased the risk of early HZ [adjusted hazard ratio ( aHR ): 0.08; 95% CI : 0.01–1.13; P ‐value = 0.062], whereas the natural killer ( NK ) cell at month 6 was protective for the occurrence of late HZ [ aHR (per 10‐cells/μl increase): 0.94; 95% CI : 0.88–1.00; P ‐value = 0.054]. In conclusion, two easily ascertainable factors (whether the patient is receiving anti‐ CMV prophylaxis and the NK cell count at month 6) might be potentially useful to tailor preventive strategies according to individual susceptibility to post‐transplant HZ.