1106 - The incidence and risk factors associated with varicella zoster virus infection in kidney transplant recipients after 1-month acyclovir prophylaxis in a CMV preemptive therapy era

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Presenting Author(s)

HK

Haein Kim

Fellow
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Jj

Joo hee jung

MS
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JJ

Jiwon Jung

Assistant Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MK

Min Jae Kim

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HK

Hyosang Kim

Assistant professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Sung Shin

Associate professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
YC

Yong Pil Chong

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
YK

Young-Hoon Kim

Associate professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SL

Sang-Oh Lee

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SC

Sang-Ho Choi

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
YK

Yang Soo Kim

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JW

Jun Hee Woo

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SP

Su-Kil Park

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DH

Duck Jong Han

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SK

Sung-Han Kim

Professor
Asan Medical Center
Seoul, Seoul-t'ukpyolsi, Republic of Korea
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Varicella zoster virus (VZV) infection is a well-known opportunistic infection in solid organ transplant recipients. Since the various strategies of the use of anti-herpetic drugs including ganciclovir or acyclovir have evolved, the epidemiology of VZV infection is changing. However, there are limited data on the recent incidence and risk factors of post-transplant VZV infection in popular preemptive ganciclovir era for CMV infection. We evaluated the incidence, risk factors and clinical characteristic of patients with development of post-transplant VZV infection in kidney transplant (KT) recipients after 1-month acyclovir prophylaxis in the hospital that adopted preemptive ganciclovir therapy for CMV infection.

Methods: All adult patients with seropositive CMV antibody admitted to a KT unit from January 2014 to December 2017 were retrospectively reviewed in a tertiary-care hospital in South Korea. Our hospital adopted preemptive ganciclovir therapy for CMV infection in all CMV seropositive KT recipients. We administered acyclovir prophylaxis for 1-month to CMV seropositive KT recipients. The primary endpoint was VZV infection development after KT.

Results: A total of 1295 KT recipients was followed up for 4295.8 person-years. The median follow-up period was 46.6 months (interquartile range (IQR) 34.3-59.5). Of the 1295 recipients, 100 (7.7%, 2.33 per 100 person-years, 95% confidence interval (CI) 1.89-2.83) patients developed VZV infection after KT. The median time for VZV infection development was 9.5 months (IQR 4.7-22.1). All patients had VZV-associated skin lesion, 9 postherpetic neuralgia, 2 visceral involvement and 3 disseminated infection. Of 100 patients, 16 patients need hospitalization due to VZV infection. In multivariate analysis, deceased donor KT (Hazard ratio (HR) 1.6; 95% CI 1.0-2.39, p = 0.05), mycophenolate maintenance immunosuppressive therapy (HR 0.3; 95% CI 0.14-0.75, p = 0.01) and rejection episode (HR 0.31; 95% CI 0.14-0.71, p = 0.01) were independently associated with VZV infection development after KT.

Conclusion: About one tenth of CMV seropositive KT recipients developed zoster after 1-month ACV prophylaxis during CMV preemptive strategy, especially in those who received deceased donor KT, mycophenolate therapy, and rejection episodes.