Boosting the Adaptive Immune Response Prevents the High Incidence of Herpes Zoster After Lung or Heart Transplantation

N. van Besouw,¹ S. Roest,² J. Zuijderwijk,¹ R. de Kuiper,¹ J. van Weezel,³ A. van der Eijk,⁴ W. Weimar,¹ P. Hal,³ O. Manintveld.²

¹Internal Medicine - Transplantation, Erasmus MC, Rotterdam, Netherlands
²Cardiology, Erasmus MC, Rotterdam, Netherlands
³Respiratory Medicine, Erasmus MC, Rotterdam, Netherlands
⁴Viroscience, Erasmus MC, Rotterdam, Netherlands.

Meeting: 2015 American Transplant Congress

Abstract number: D271

Keywords: B cells, Reinfection, T cells, Vaccination

Session Information

Session Name: Poster Session D: Viral Infections

Session Type: Poster Session

Date: Tuesday, May 5, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Purpose Primary varicella zoster virus (VZV) infection causes varicella and lifelong latent infection in ganglia from which it may reactivate leading to herpes zoster (HZ). We reported that VZV-reactive memory T-cells are significantly lower in transplant recipients compared to controls with significantly lower VZV-specific IgG titres post-transplantation compared to pre-transplantation. We investigated the incidence of HZ post-transplantation and questioned whether the VZV-specific T-cell and B-cell memory responses are recovered after VZV reactivation.

Methods The records of patients post lung transplantation (LuTx: n=120) and heart transplantation (HTx: n=222) between Jan 2000 and Mar 2014 were analysed for VZV-PCR DNA up to Aug 2014. VZV-specific B and T-cell memory responses before and after HZ (n=5) were compared to patients without HZ (n=5).

Results VZV infection was clinically diagnosed and confirmed by PCR in 16 LuTx and 38 HTx recipients. Three patients who were VZV IgG negative pre-transplantation, developed primary VZV infection 1.2 years post-LuTx and 4.7 and 7.8 years post-HTx. 15 patients developed HZ post-LuTx: two had systemic dissemination, of which one died six days later, and 13 had uncomplicated cutaneous HZ (≤3 dermatomes). 36 patients developed HZ post-HTx: 2 had systemic dissemination, 5 had cranial nerve involvement and 29 had uncomplicated cutaneous HZ. The overall incidence rate of HZ post-LuTx (37.1 cases/1000 PY) or HTx (30.8 cases/1000 PY) was significantly higher than an age-matched healthy population (7-8 cases/1000 PY). In 4 patients the number of VZV-specific IgG producing B-cells increased after HZ to higher frequencies than those without HZ (p=0.06). The percentage of VZV-reactive CD4 and CD8 central and effector memory T-cells increased in all patients after HZ to significantly higher frequencies compared to those without HZ (p=0.03).

Conclusion HZ is a frequent complication post-LuTx or HTx and increases VZV-specific T- and B-cell memory responses. Boosting the VZV adaptive immune response by prophylactic VZV vaccination pre-transplantation may limit the incidence of HZ post-transplantation.

To cite this abstract in AMA style:

Besouw Nvan, Roest S, Zuijderwijk J, Kuiper Rde, Weezel Jvan, Eijk Avander, Weimar W, Hal P, Manintveld O. Boosting the Adaptive Immune Response Prevents the High Incidence of Herpes Zoster After Lung or Heart Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/boosting-the-adaptive-immune-response-prevents-the-high-incidence-of-herpes-zoster-after-lung-or-heart-transplantation/. Accessed May 9, 2025.

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