Chickenpox infection after renal transplantation

BACKGROUND Chicken pox, although a common infection among children, is rare in immunocompromised patients, particularly renal transplant recipients, and carries a very high incidence of morbidity and mortality There is little data on chickenpox in adult renal transplant recipients, although reports have suggested that it may follow a virulent course requiring frequent hospitalization, and in severe cases can cause death. AIMS To evaluate the incidence, severity and complications of a varicella/chickenpox infection in renal transplant recipients over 10 years follow-up. RESULTS An incidence of 1.48% of our patients were diagnosed with varicella infection during this 10-year period from June 2000 to June 2010 in our live-related renal transplant program, with a median patient age of 39 years (range 21-54 years). Graft dysfunction was observed among five patients following the infection, two of whom became dialysis-dependent. The other three had mild graft dysfunction from which they subsequently recovered, suggesting that infection was responsible for graft dysfunction. None of them developed rejection following exposure or with modification of immunosuppression. All of our patients required admission with 47.8% presenting with various presentations, with orchitis, pancreatitis, encephalitis and gastritis each affecting 8.6% of the patients. All patients were managed with intravenous acyclovir for 2 weeks followed by oral acyclovir for 3 months. The infection was associated with an increased mortality of 13.4% due to superadded infections and central nervous system involvement in one patient with fatal bilateral pneumonia. CONCLUSIONS This infection, which is a benign disease with a largely stable course among the general population, can have severe outcomes for immunocompromised patients, accounting for almost 90% with significant morbidity and mortality in the 8.6% of infected patients, thus highlighting the importance of pre-transplant vaccination in this subgroup of the population.