Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab

Maria L Alcaide, Lilian Abbo, Jose R. Pano, Jeffrey Gaynor, Panagiotis Tryphonopoulos, Debbie Weppler, Jang I. Moon, Andreas G. Tzakis, Michele I Morris

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: The incidence of herpes zoster (HZ) infection in liver transplant recipients prior to the use of induction therapy with monoclonal antibodies has been reported as being 1.2-18%. We studied the occurrence of HZ in liver transplant recipients that received induction therapy with alemtuzumab (Campath 1H®). Material and methods: This was a retrospective review of primary liver transplant recipients who received alemtuzumab as induction therapy at our center. HZ infection was diagnosed clinically as the presence of a characteristic vesicular rash in a dermatomal distribution without any further virological confirmation. Results: A total of 118 liver transplant recipients were treated with alemtuzumab between August 2002 and August 2005. Twelve patients developed HZ infection, and the cumulative probability of a patient developing HZ infection by 36 months post-transplant ± 1SE was estimated as 16.5 ± 5.0%. The median time for onset of the infection was 10.2 months (range 4.7-30.7) after the transplant. All patients had only one dermatomal distribution, and none developed systemic infection or complications such as postherpetic neuropathy. All patients except one were treated with systemic intravenous acyclovir. One patient received famciclovir. All of the patients had received ganciclovir during the post-transplant period but were not receiving any other antiviral medication at the time of the infection. Conclusion: Herpes zoster infection has previously been reported as a frequent complication of liver transplantation. Our study suggests that it occurs in approximately 16% of patients receiving induction therapy with alemtuzumab. Although alemtuzumab is a powerful immunosuppressive agent and there is still little information regarding its long-term safety when used in liver transplantation, our data do not suggest any increase in the occurrence and complications of HZ.

Original languageEnglish
Pages (from-to)502-507
Number of pages6
JournalClinical Transplantation
Volume22
Issue number4
DOIs
StatePublished - Jul 1 2008

Fingerprint

Herpes Zoster
Liver Transplantation
Infection
Liver
Therapeutics
Transplants
Ganciclovir
Acyclovir
alemtuzumab
Immunosuppressive Agents
Exanthema
Antiviral Agents
Monoclonal Antibodies
Safety
Transplant Recipients
Incidence

Keywords

  • Alemtuzumab
  • Herpes
  • Liver
  • Transplantation
  • Zoster

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab. / Alcaide, Maria L; Abbo, Lilian; Pano, Jose R.; Gaynor, Jeffrey; Tryphonopoulos, Panagiotis; Weppler, Debbie; Moon, Jang I.; Tzakis, Andreas G.; Morris, Michele I.

In: Clinical Transplantation, Vol. 22, No. 4, 01.07.2008, p. 502-507.

Research output: Contribution to journalArticle

Alcaide, Maria L ; Abbo, Lilian ; Pano, Jose R. ; Gaynor, Jeffrey ; Tryphonopoulos, Panagiotis ; Weppler, Debbie ; Moon, Jang I. ; Tzakis, Andreas G. ; Morris, Michele I. / Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab. In: Clinical Transplantation. 2008 ; Vol. 22, No. 4. pp. 502-507.
@article{6e8e31e702974145a800cf8852abaecc,
title = "Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab",
abstract = "Background: The incidence of herpes zoster (HZ) infection in liver transplant recipients prior to the use of induction therapy with monoclonal antibodies has been reported as being 1.2-18{\%}. We studied the occurrence of HZ in liver transplant recipients that received induction therapy with alemtuzumab (Campath 1H{\circledR}). Material and methods: This was a retrospective review of primary liver transplant recipients who received alemtuzumab as induction therapy at our center. HZ infection was diagnosed clinically as the presence of a characteristic vesicular rash in a dermatomal distribution without any further virological confirmation. Results: A total of 118 liver transplant recipients were treated with alemtuzumab between August 2002 and August 2005. Twelve patients developed HZ infection, and the cumulative probability of a patient developing HZ infection by 36 months post-transplant ± 1SE was estimated as 16.5 ± 5.0{\%}. The median time for onset of the infection was 10.2 months (range 4.7-30.7) after the transplant. All patients had only one dermatomal distribution, and none developed systemic infection or complications such as postherpetic neuropathy. All patients except one were treated with systemic intravenous acyclovir. One patient received famciclovir. All of the patients had received ganciclovir during the post-transplant period but were not receiving any other antiviral medication at the time of the infection. Conclusion: Herpes zoster infection has previously been reported as a frequent complication of liver transplantation. Our study suggests that it occurs in approximately 16{\%} of patients receiving induction therapy with alemtuzumab. Although alemtuzumab is a powerful immunosuppressive agent and there is still little information regarding its long-term safety when used in liver transplantation, our data do not suggest any increase in the occurrence and complications of HZ.",
keywords = "Alemtuzumab, Herpes, Liver, Transplantation, Zoster",
author = "Alcaide, {Maria L} and Lilian Abbo and Pano, {Jose R.} and Jeffrey Gaynor and Panagiotis Tryphonopoulos and Debbie Weppler and Moon, {Jang I.} and Tzakis, {Andreas G.} and Morris, {Michele I}",
year = "2008",
month = "7",
day = "1",
doi = "10.1111/j.1399-0012.2008.00816.x",
language = "English",
volume = "22",
pages = "502--507",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Herpes zoster infection after liver transplantation in patients receiving induction therapy with alemtuzumab

AU - Alcaide, Maria L

AU - Abbo, Lilian

AU - Pano, Jose R.

AU - Gaynor, Jeffrey

AU - Tryphonopoulos, Panagiotis

AU - Weppler, Debbie

AU - Moon, Jang I.

AU - Tzakis, Andreas G.

AU - Morris, Michele I

PY - 2008/7/1

Y1 - 2008/7/1

N2 - Background: The incidence of herpes zoster (HZ) infection in liver transplant recipients prior to the use of induction therapy with monoclonal antibodies has been reported as being 1.2-18%. We studied the occurrence of HZ in liver transplant recipients that received induction therapy with alemtuzumab (Campath 1H®). Material and methods: This was a retrospective review of primary liver transplant recipients who received alemtuzumab as induction therapy at our center. HZ infection was diagnosed clinically as the presence of a characteristic vesicular rash in a dermatomal distribution without any further virological confirmation. Results: A total of 118 liver transplant recipients were treated with alemtuzumab between August 2002 and August 2005. Twelve patients developed HZ infection, and the cumulative probability of a patient developing HZ infection by 36 months post-transplant ± 1SE was estimated as 16.5 ± 5.0%. The median time for onset of the infection was 10.2 months (range 4.7-30.7) after the transplant. All patients had only one dermatomal distribution, and none developed systemic infection or complications such as postherpetic neuropathy. All patients except one were treated with systemic intravenous acyclovir. One patient received famciclovir. All of the patients had received ganciclovir during the post-transplant period but were not receiving any other antiviral medication at the time of the infection. Conclusion: Herpes zoster infection has previously been reported as a frequent complication of liver transplantation. Our study suggests that it occurs in approximately 16% of patients receiving induction therapy with alemtuzumab. Although alemtuzumab is a powerful immunosuppressive agent and there is still little information regarding its long-term safety when used in liver transplantation, our data do not suggest any increase in the occurrence and complications of HZ.

AB - Background: The incidence of herpes zoster (HZ) infection in liver transplant recipients prior to the use of induction therapy with monoclonal antibodies has been reported as being 1.2-18%. We studied the occurrence of HZ in liver transplant recipients that received induction therapy with alemtuzumab (Campath 1H®). Material and methods: This was a retrospective review of primary liver transplant recipients who received alemtuzumab as induction therapy at our center. HZ infection was diagnosed clinically as the presence of a characteristic vesicular rash in a dermatomal distribution without any further virological confirmation. Results: A total of 118 liver transplant recipients were treated with alemtuzumab between August 2002 and August 2005. Twelve patients developed HZ infection, and the cumulative probability of a patient developing HZ infection by 36 months post-transplant ± 1SE was estimated as 16.5 ± 5.0%. The median time for onset of the infection was 10.2 months (range 4.7-30.7) after the transplant. All patients had only one dermatomal distribution, and none developed systemic infection or complications such as postherpetic neuropathy. All patients except one were treated with systemic intravenous acyclovir. One patient received famciclovir. All of the patients had received ganciclovir during the post-transplant period but were not receiving any other antiviral medication at the time of the infection. Conclusion: Herpes zoster infection has previously been reported as a frequent complication of liver transplantation. Our study suggests that it occurs in approximately 16% of patients receiving induction therapy with alemtuzumab. Although alemtuzumab is a powerful immunosuppressive agent and there is still little information regarding its long-term safety when used in liver transplantation, our data do not suggest any increase in the occurrence and complications of HZ.

KW - Alemtuzumab

KW - Herpes

KW - Liver

KW - Transplantation

KW - Zoster

UR - http://www.scopus.com/inward/record.url?scp=48249083426&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=48249083426&partnerID=8YFLogxK

U2 - 10.1111/j.1399-0012.2008.00816.x

DO - 10.1111/j.1399-0012.2008.00816.x

M3 - Article

C2 - 18627401

AN - SCOPUS:48249083426

VL - 22

SP - 502

EP - 507

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 4

ER -