Varicella in a pediatric heart transplant population on nonsteroid maintenance immunosuppression

Da. Dodd et al., Varicella in a pediatric heart transplant population on nonsteroid maintenance immunosuppression, PEDIATRICS, 108(5), 2001, pp. NIL_12-NIL_15
Citations number
Categorie Soggetti
Pediatrics,"Medical Research General Topics
Journal title
ISSN journal
0031-4005 → ACNP
Year of publication
NIL_12 - NIL_15
SICI code
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 on.