van Besouw Nicole M, van Hal Peter Th W, Zuijderwijk Joke M, de Kuiper Ronella, Hoek Rogier A S, van Weezel Jan J, van der Eijk Annemiek A, Verjans Georges M G M, Weimar Willem
Department of Internal Medicine-Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Respiratory Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands.
J Heart Lung Transplant. 2016 Dec;35(12):1435-1442. doi: 10.1016/j.healun.2016.04.009. Epub 2016 May 6.
Varicella zoster virus (VZV)-specific memory T cells are significantly lower in transplant recipients than in controls. In addition, VZV-specific immunoglobulin G titers are significantly lower after than before transplantation. Data on the incidence and timing of herpes zoster (HZ) after lung transplantation are limited. This study had two aims: first, we investigated the incidence and severity of HZ after lung transplantation; second, we determined the systemic VZV-specific T-cell and B-cell memory responses before and after HZ.
The records of 119 patients who underwent transplantation were analyzed for post-transplant HZ. The VZV-specific B-cell and T-cell memory responses of 5 patients before and after HZ were compared with 5 patients without HZ by enzyme-linked immunospot assay and flow cytometry, respectively.
HZ was clinically diagnosed and confirmed by polymerase chain reaction on blister fluids and/or plasma in 17 transplant recipients. Uncomplicated cutaneous HZ was present in 12 patients, and 5 patients had disseminated HZ, of whom 1 died. The incidence of HZ after transplantation (38.2 cases/1,000 patient-years) was significantly higher than the age-matched healthy population (7-8 cases/1,000 patient-years). The frequency of VZV-specific immunoglobulin G-producing B cells (p = 0.06) and the percentage of VZV-specific CD4 and CD8 memory T cells increased after HZ to higher frequencies than in patients without HZ (p = 0.03). This was mainly attributed to VZV-reactive effector memory CD4 T cells (p = 0.02) and central memory (p = 0.02) and effector memory (p = 0.03) CD8 T cells.
Lung transplant recipients are highly prone to develop HZ with severe complications. Despite deep immunosuppression, HZ boosted their systemic VZV-specific B-cell and T-cell memory responses.
移植受者中水痘带状疱疹病毒（VZV）特异性记忆T细胞显著低于对照组。此外，移植后VZV特异性免疫球蛋白G滴度显著低于移植前。肺移植后带状疱疹（HZ）的发病率和发病时间的数据有限。本研究有两个目的：第一，我们调查了肺移植后HZ的发病率和严重程度；第二，我们确定了HZ前后全身VZV特异性T细胞和B细胞记忆反应。
分析119例接受移植患者的记录，以了解移植后HZ情况。分别通过酶联免疫斑点试验和流式细胞术，比较了5例HZ患者前后与5例无HZ患者的VZV特异性B细胞和T细胞记忆反应。
17例移植受者经临床诊断HZ，并通过水疱液和/或血浆的聚合酶链反应得到证实。12例患者出现无并发症的皮肤HZ，5例患者出现播散性HZ，其中1例死亡。移植后HZ的发病率（38.2例/1000患者年）显著高于年龄匹配的健康人群（7 - 8例/1000患者年）。HZ后，产生VZV特异性免疫球蛋白G的B细胞频率（p = 0.06）以及VZV特异性CD4和CD8记忆T细胞百分比增加，且高于无HZ患者（p = 0.03）。这主要归因于VZV反应性效应记忆CD4 T细胞（p = 0.02）以及中枢记忆（p = 0.02）和效应记忆（p = 0.03）CD8 T细胞。
肺移植受者极易发生HZ并伴有严重并发症。尽管存在深度免疫抑制，但HZ增强了他们全身VZV特异性B细胞和T细胞记忆反应。
