*Purpose: Varicella zoster infection is a serious complication of immunosuppression in renal transplant recipients. We examined the prevalence of VZV infection in renal transplant patients to try to identify any risk factors that could be modified.

*Methods: We retrospectively reviewed medical records of all patients who underwent renal transplantation at our center between the years 2006 to 2017 to identify patients with VZV infection post-transplantation as demonstrated by positive microbiology testing results (DFA or PCR testing of lesions of blood).

*Results: During the years of study, 3380 patients underwent renal transplantation, and out of these, 30 patients were diagnosed with VZV. 18 patients (60%) were male, median age was 55.5 years. Median time of onset of VZV infection post-transplant was 1.4 years. 13 patients (43%) contracted VZV within one year of transplant. 8 patients (26%) suffered rejection and augmentation of immunosuppression within the 12 months prior to infection, and the median time to infection post rejection was 6 months. Only 2 patients had documented vaccination prior to transplant. 10 patients (33%) had disseminated disease, 2 of which had recent rejection and 7 were transplanted within one year of infection. All patients had a dermatomal distribution of disease, and the disseminated cases had lesions in more than 2 dermatomes. None of the patients had positive blood PCRs. None of the patients had chickenpox. 1 of the 30 patients was on prophylaxis at the time of the diagnosis.

*Conclusions: In this series of kidney transplant recipients, VZV infection was often seen in the first or second year after transplant, after antiviral prophylaxis had been discontinued. Disseminated disease is not an uncommon occurrence, and often requires hospitalization. It is important to understand the patterns of occurrence for this infection, because as the average age of kidney transplant recipients continues to increase, incidence of this disease will likely increase. Extension or restarting of antiviral prophylaxis may be beneficial in the highest risk patients.

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