Broyer M, Tete M J, Guest G, Gagnadoux M F, Rouzioux C
Department of Pediatric Nephrology, Hôpital Necker-Enfants Malades, Paris, France.
Pediatrics. 1997 Jan;99(1):35-9. doi: 10.1542/peds.99.1.35.
To determine the long-term prevalence of varicella infection and herpes zoster after kidney transplantation and to assess the effectiveness of varicella immunization with the Oka attenuated strain.
This study involved 704 children and adolescents who received a kidney graft in our institution from 1973 to 1994 and had routinely been given varicella vaccine beginning in 1980 in preparation for transplantation.
After vaccination 62% of these patients still had varicella/zoster (VZ) antibodies at 1 year and 42% after 10 years. After transplantation the incidence of varicella was significantly lower, 26/212 (12%), in patients who received immunization than in those who did not and had no history of varicella, 22/49 (45%). The disease was also significantly less severe in the vaccinated patients (three deaths among naive patients vs none among vacciness). In the vaccinees, varicella infection was observed only in those who did not develop or lost VZ antibodies; in addition, 21 patients of this subgroup had an asymptomatic seroconversion. Four of the 415 patients with a history of varicella had another episode of benign varicella after grafting. Herpes zoster was observed in 76 of the 704 patients included in the study. The prevalence differed according to VZ status at the time of grafting: 13% in patients with a history of varicella, 7% in the vacciness, and 38% in the naive patients at grafting who developed varicella. Three rejection episodes occurred in association with a varicella episode and four with a zoster episode, but graft function was only transiently impaired, and as a whole varicella or zoster did not significantly affect graft function or survival.
Naive VZ patients with a kidney graft are at risk to develop severe varicella and this may be effectively prevented by available immunization.
确定肾移植后水痘感染和带状疱疹的长期患病率，并评估使用Oka减毒株进行水痘免疫的有效性。
本研究纳入了1973年至1994年在我们机构接受肾移植的704名儿童和青少年，自1980年起为准备移植他们常规接种水痘疫苗。
接种疫苗后，这些患者中62%在1年后仍有水痘/带状疱疹（VZ）抗体，10年后为42%。移植后，接种疫苗的患者中水痘发病率显著较低，为26/212（12%），低于未接种且无水痘病史的患者，后者为22/49（45%）。接种疫苗的患者中疾病也明显较轻（未接种疫苗患者中有3例死亡，而接种疫苗患者中无死亡）。在接种疫苗者中，水痘感染仅在未产生或失去VZ抗体的患者中观察到；此外，该亚组中有21名患者有无症状血清转化。415名有水痘病史的患者中有4名在移植后再次发生良性水痘。在纳入研究的704名患者中，有76名发生带状疱疹。患病率根据移植时的VZ状态而有所不同：有水痘病史的患者中为13%，接种疫苗者中为7%，移植时发生水痘的未接种疫苗患者中为38%。有3次排斥反应发作与水痘发作相关，4次与带状疱疹发作相关，但移植功能仅短暂受损，总体而言，水痘或带状疱疹并未显著影响移植功能或存活。
未接种VZ疫苗的肾移植患者有发生重症水痘的风险，现有的免疫接种可有效预防。
