Herpes zoster infection after liver transplantation: a case-control study

Prior case series have suggested that herpes zoster (HZ) after orthotopic liver transplantation (OLT) may lead to serious complications due to visceral involvement. We sought to determine the incidence, risk factors, and long term outcomes of HZ after OLT. Clinical data from September 1993 to April 2004 were collected on all cases of HZ after OLT, and at the same post-OLT time points in age, gender, and transplant-year-matched HZ-negative controls. Risk factors for HZ infection and long-term outcomes were compared between cases and controls. A total of 29 patients developed HZ at a median of 4.9 years (range .5-12.9) after OLT. All HZ infections except 1 were localized to a single dermatome. Only 8 (28%) were hospitalized and 16 (55%) were treated with oral antivirals alone. No patients developed visceral involvement or died of HZ infection. No risk factors for HZ infection were identified on multivariate analysis. Of the long-term outcomes, the estimated 10-year survival was lower (P = .05) for cases than controls. The lower survival in HZ cases was not directly attributable to HZ infection. In conclusion, this study is the largest series on HZ after OLT. HZ is neither a common nor a serious infection after OLT and can be managed with antiviral therapy with a low likelihood of visceral dissemination.