Chickenpox in adult renal transplant recipients.

Five of 610 adults developed chickenpox between 35 days and 9.2 years after renal transplantation, and only one patient survived. All patients received prednisolone and azathioprine during the incubation period. Corticosteroid therapy was continued, but azathioprine was stopped after diagnosis. Four patients were treated with acyclovir, but three were given suboptimal doses. The patient who survived had been taking the lowest dose of azathioprine and was given the recommended dose of acyclovir. All patients who died developed disseminated intravascular coagulation, and at postmortem examination were found to have had cerebral haemorrhage. None of the patients treated with acyclovir had evidence of active varicella-zoster virus infection at post-mortem examination, but two had disseminated bacterial and fungal infections. Chickenpox follows a severe and often fatal course in adults with renal transplants. Prompt acyclovir therapy can be effective, provided an adequate dose is given. Attention should be directed towards prevention by the identification and immunisation of at risk patients prior to transplantation.