Introduction: Herpes zoster (HZ) is the clinical manifestation of varicella zoster virus (VZV) reactivation and occurs more frequently in people with a suppressed immune system. We studied the incidence of HZ in a cohort of renal transplant recipients. Moreover we assessed the efficacy of vaccination to increase VZV IgG titres in kidney transplant candidates to comparable levels as in healthy persons.

Methods: In a cohort of 522 renal transplant recipients, transplanted between 2003-2008, incidence and complications of HZ were analysed up to July 31, 2013. In a prospective study, patients ≥50 years awaiting renal transplantation (n=23) were vaccinated with Zostavax®. Gender and age-matched kidney transplant donors (n=22) were included as controls. VZV-specific IgG titres were determined before, 1 and 3 months after vaccination.

Results: HZ prevalence was 21.3%. HZ incidence was 12.5 cases/1000 person years (PY) under immunosuppressive therapy (IS) in patients <50 years, and 22.7 cases/1000 PY in patients ≥50 years. HZ incidence in the general population is significantly lower (7-8 cases/1000 PY). Complications (bacterial infections, systemic dissemination, death) only occurred in HZ cases under IS. After vaccination, VZV-IgG titres significantly increased at 1 and 3 months compared to before vaccination in both patients (1 mo: p=0.0003, 3 mo: p=0.0006) and donors (1 mo: p=0.0002, 3 mo: p<0.0001). The increment in VZV-IgG titers from pre-vaccination to 1 and 3 months post vaccination was comparable between patients and donors. One patient had a mild HZ episode at 11 months post-transplantation (16 months post-vaccination).

Discussion: HZ incidence post renal transplantation is high. Remarkably, in contrast to hepatitis B vaccination, VZV vaccination equally increased virus specific IgG titres in patients with renal failure compared to healthy individuals. ESRD patients can be effectively vaccinated to prevent herpes zoster.

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