Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Clin Microbiol Infect. 2023 Jul;29(7):911-917. doi: 10.1016/j.cmi.2023.02.014. Epub 2023 Mar 1.
Kidney transplant (KT) recipients have an increased risk of herpes zoster (HZ) and its complications. Although recombinant zoster vaccine is favoured over zoster vaccine live (ZVL), ZVL is also recommended to prevent HZ for KT candidates. We aimed to evaluate the clinical effectiveness of ZVL in KT recipients immunized before transplantation.
Adult patients who received kidney transplantation from January 2014 to December 2018 were enrolled. Patients were observed until HZ occurrence, death, loss of allograft, loss to follow-up, or 5 years after transplantation. The inverse probability of the treatment-weighted Cox proportional hazard model was used to compare the incidence of HZ after transplantation between vaccinated and unvaccinated patients.
A total of 84 vaccinated and 340 unvaccinated patients were included. The median age was higher in the vaccinated group (57 vs. 54 years, p 0.003). Grafts from deceased donors were more frequently transplanted in the unvaccinated group (16.7% vs. 51.8%, p < 0.001). Five-year cumulative HZ incidence was 11.9%, which translated to 26.27 (95% CI, 19.33-34.95) per 1000 person-years. The incidence in the vaccinated and unvaccinated groups was 3.9% and 13.7%, respectively. After adjustment, vaccination showed significant protective effectiveness against HZ (adjusted hazard ratio, 0.18, 95% CI, 0.05-0.60). In addition, all four cases of disseminated zoster occurred in the unvaccinated group.
Our study, the first on the clinical effectiveness of zoster vaccines for KT recipients, suggests that ZVL before transplantation effectively prevents HZ.
肾移植（KT）受者带状疱疹（HZ）及其并发症的风险增加。虽然重组带状疱疹疫苗优于带状疱疹活疫苗（ZVL），但也推荐 ZVL 用于预防 KT 候选者的 HZ。我们旨在评估 ZVL 在移植前免疫的 KT 受者中的临床效果。
纳入 2014 年 1 月至 2018 年 12 月接受肾移植的成年患者。观察患者至 HZ 发生、死亡、移植物丢失、随访丢失或移植后 5 年。采用逆概率治疗加权 Cox 比例风险模型比较疫苗接种和未接种患者移植后 HZ 的发生率。
共纳入 84 名疫苗接种患者和 340 名未接种患者。疫苗接种组的中位年龄较高（57 岁比 54 岁，p<0.003）。未接种组更常接受已故供者的移植物（16.7%比 51.8%，p<0.001）。5 年累积 HZ 发生率为 11.9%，即每 1000 人年 26.27 例（95%CI，19.33-34.95）。疫苗接种组和未接种组的发生率分别为 3.9%和 13.7%。调整后，疫苗接种对 HZ 具有显著的保护作用（调整后的危险比，0.18，95%CI，0.05-0.60）。此外，所有 4 例播散性带状疱疹均发生在未接种组。
我们的研究是第一项关于 ZVL 对 KT 受者的临床效果的研究，表明移植前 ZVL 可有效预防 HZ。
