Objective. Varicella-zoster virus has been reported to produce serious, oft
en life-threatening, disease in immunosuppressed patients with a variety of
diagnoses. The impact of this virus on the young child after heart transpl
antation has not been reported.
Methods. We reviewed the charts of 28 children who were <10 years of age at
heart transplantation and had at least 1 year of follow-up. The median fol
low-up period was 7 years (1.4-13.0 years). All were seronegative for varic
ella-zoster virus before transplantation. Fourteen (50%) developed varicell
a at a median time posttransplantation of 3.3 years. The first 7 were admit
ted for intravenous acyclovir for 3 days followed by oral acyclovir for 7 d
ays. The last 7 were treated as outpatients with oral valacyclovir for 7 da
ys (n = 6) or with oral acyclovir for 10 days (n = 1).
Results. Intravenous and oral regimens both were well tolerated and were wi
thout complications. No patient was receiving steroids at the time that the
y developed their initial episode of varicella. One patient was receiving s
teroids for therapy of posttransplantation lymphoproliferative disease when
she developed recurrent varicella or generalized zoster. No episodes of re
jection were attributed to the varicella-zoster virus infection. There were
no episodes of localized zoster. All patients experienced seroconversion f
rom undetectable to detectable antibody titers early after varicella, and 1
2 of the 14 patients continued to have persistent detectable titers in late
follow-up. Two of the 14 who received chemotherapy or enhanced immunosuppr
ession after retransplantation transiently lost detectable varicella-zoster
virus antibodies but currently have detectable titers.
Conclusions. Primary varicella-zoster infection was well tolerated in our y
oung pediatric heart transplant recipients, with no serious complications.
We now reserve inpatient/intravenous therapy for those who are unable to to
lerate oral medications or those who are receiving enhanced immunosuppressi