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Early Experience with Varicella Vaccination in Pediatric Heart Transplant Recipients

A. Dipchand, M. Seifert-Hansen

The Hospital of Sick Children, Toronto, ON, Canada

Meeting: 2022 American Transplant Congress

Abstract number: 57

Keywords: Heart, Pediatric, Vaccination

Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)

Session Information

Session Name: Cytomegalovirus and other Herpes Viruses

Session Type: Rapid Fire Oral Abstract

Date: Sunday, June 5, 2022

Session Time: 3:30pm-5:00pm

 Presentation Time: 4:40pm-4:50pm

Location: Hynes Ballroom B

*Purpose: International consensus guidelines to vaccinate children after transplant with varicella (VZV) vaccine exclude heart recipients due to insufficient evidence for safety, seroconversion rate, and adverse event profile. The purpose of this study is to report our novel early experience with VZV vaccination in children following heart transplantation (HTx).

*Methods: Single center, retrospective cohort study of pediatric HTx recipients who underwent VZV vaccination. Medical records were reviewed for demographic data, immunosuppression, immune testing, VZV IgG, and adverse events.

*Results: 31 children received at least 1 dose of VZV vaccine at a mean of 9 y post-HTx.(Table 1) 52% were on tacrolimus monotherapy; 42% were on tacrolimus/MMF. Table 2 summarizes vaccine-related data. Mean lymphocyte count was normal. CD3+CD4+ were on average low normal though a wide range. 21 children received 2 doses a median of 6.3 mos apart. 17 patients have had f/u serology: 16/17 (94%) VZV IgG+;13/14 (93%) VZV IgG+ at a mean of 6.3 mos after dose #2; 3/3 VZV IgG+ at a mean of 10.9 mos after dose#1. 10 (32%) patients experienced an adverse event (Table 3), most a rash at a mean of 18.7±6.1 d. Most were a few small raised red spots that self-resolved in 1-3 d; 1 was vesicular, 4 were pruritic. There were no major adverse events. 1 patient received anti-viral therapy early in the experience after a rash duration of 7 d (n=20 spots, no vesicles, no systemic symptoms).

*Conclusions: This is the first report in the literature of systematic live-attenuated VZV vaccination in a cohort of children following heart transplantation. Though consensus guidelines defer VZV vaccination in these patients and recommend caution in the setting of MMF use, the observations herein support that select pediatric heart transplant patients can be safely vaccinated with VZV vaccine with a 94% early seroconversion rate and a mild adverse event profile.

Table 1: Patient Characteristics
Median age at HTx 0.72 y (IQR 1.18); Range 0.05-15.9 y
Female 18 (58%)
Diagnosis Cardiomyopathy 17 (55%), Congenital heart disease 12 (39%), Other 2 (6%)
Blood group O 17 (55%), A 7 (23%), AB 4 (13%), B 3 (10%)
ABO-incompatible transplant 12 (39%)
Immunosuppression Tacrolimus monotherapy 16 (52%), Tacrolimus/MMF 13 (42%), Sirolimus/MMF 1 (3%), Sirolimus/Tacrolimus 1 (3%)
Tacrolimus target <4: 4 (13%), 4-6: 5 (16%), 5-7: 18 (58%), 6-8: 2 (6%), 8-10: 1 (3%)
Table 2: Vaccination Data and Outcomes
Median age at 1st dose (n=31) 11.74 y (IQR 6.72); Range 3.2-17.9 y
Mean time post-HTx at 1st dose (n=31) 9.1+/-4.7 y
Mean absolute lymphocyte count 1.89+/-0.72 x109/L
Mean absolute CD3+CD4+ count 665+/-283 cells/uL, Range 390-1563 cells/uL
Mean IgG level 11.63+/-2.69 g/L
Median time between doses (n=21) 6.3 mos (IQR 2.1), Range 3.5-17.5 mos
VZV serology (n=17) Positive 16 (94%), Negative 1 (6%)
Mean time post-dose#2 to positive serology 6.3+/-2.3 mos
Table 3: Adverse Events
Patients with any adverse event 10 (32%)
Local reaction 2 (6%)
Rash 9 (29%); small raised red spots 6, small flat red/brown spots 2, vesicles 1
Number of spots <10: 2, 11-20: 6, 21-30: 1
Duration (days) 1 day: 1; 2-3 days: 5; 3-4 days: 2; 7 days: 1
Mean time to rash 18.7+/-6.1 days
Fever, systemic symptoms, disseminated disease, hospitalization, rejection 0
Anti-viral therapy (oral) 1
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To cite this abstract in AMA style:

Dipchand A, Seifert-Hansen M. Early Experience with Varicella Vaccination in Pediatric Heart Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/early-experience-with-varicella-vaccination-in-pediatric-heart-transplant-recipients/. Accessed May 30, 2025.

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