Background: We created a retrospective database of solid organ transplant (SOT) recipients using innovative data mining tools. This study describing the epidemiology of Varicella Zoster Virus (VZV) reactivation in SOT serves as a proof of concept of such techniques in clinical research.
Methods: The study design was a retrospective single center cohort study. Using data mining tools, information was extracted from the electronic medical record and merged with data from the Scientific Registry of Transplant Recipients. First SOT from 1/1/2010-12/31/2016 were included. Charts of subjects with ICD9/10 codes related to VZV/Herpes infections; positive VZV PCR, DFA or cultures; and recipients of acyclovir, valacyclovir or famciclovir were manually reviewed. The cumulative incidence was calculated using the Kaplan-Meier method. Cox proportional hazards models were used to identify risk factors for VZV reactivation among heart transplant (HT) recipients.
Results: 1076 SOT recipients met inclusion criteria (203 Heart, 395 Lung, 280 Kidney, 198 Liver). 49 patients experienced at least 1 episode of VZV reactivation; median time post-transplant was 2.25 years (IQR 1.44-4.20 years). The cumulative incidence was 11.9% at 8 years post-transplant. Heart transplant (HT) recipients were at highest risk (Figure 1), with an 8-year cumulative incidence of 26.3% (Figure 2). 39/49 (80%) patients presented with localized disease and 4/49 (8%) with disseminated disease. In multivariable analysis (Figure 3), the risk of VZV reactivation in HT recipients after 12 months (47 patients) was associated with CMV infection before 12 months (HR [95%CI] = 4.74 [1.67-13.47]). Postherpetic neuralgia (PHN) occurred in 23/49 (47%), recurrence in 3/49 (6%), and other complications in 11/49 (22%). In univariable analysis, no risk factors for PHN were identified.
Conclusion: HT recipients are at highest risk for VZV reactivation. CMV infection before 1 year is associated with increased risk of VZV reactivation after 1 year in HT. This information may help design clinical trials of the recombinant zoster vaccine.
D. Xie, None
C. Yek, None
T. Liu, None
X. Li, None
B. Adams-Huet, None
R. W. Haley, None
D. Greenberg, None
R. La Hoz, None
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