|Reference||Patient’s presentation||Results||Elaborations on results||Main conclusions||Study quality|
|Complication||Length of stay (LOS)||Mortality|
|Ong CY, et al. (2018) ||
-66 patients developed varicella in the 12-year review of all ESRD patients.|
-Age range: 19–89 years old (median:53)
-37 male patients.
-Timing of infection: 6 to 19 years post diagnosis of ESRD.
-24 patients developed at least one complication.|
Encephalitis, meningitis, pneumonia/pneumonitis.
-LOS: median 10 days
-9 died (13.6%)
-ESRD patients had significant morbidity and mortality associated with varicella infection.|
-Screen for seronegative patients and consider vaccinate them.
|Errasti P, et al. (1999) ||-31 y.o. Woman, 5 years post-transplant, admitted for acute epigastric pain with 3 days vesicular rash.||+||NA||+||
-Fulminant hepatitis (post-mortem showed massive hepatic necrosis).
-Died in 2 days.
-Chickenpox often follows severe and often fatal course in adults with renal transplantation.|
-Vaccine appears to prevent clinical varicella following subsequent exposure.
|-29 y.o. Man, 17 years post-transplant, admitted for confluent-haemorrhagic rash.||+||NA||+||
-Encephalitis (post-mortem showed cerebral oedema).|
-Disseminated intravascular coagulation (DIC) with multiple bleeding sites.
-Secondary Staphylococcus bacteraemia.
|−59 y.o. Man, 2 years post-transplant, had few vesicular rash. Exposed to his son who had varicella 4 weeks ago.||–||NA||–||-No complication|
|-69 y.o. Woman, 8 months post-transplant, admitted for vesicular rash and fever.||–||NA||–||-No complication|
|Ishikawa N, et al. (2000) ||-29 y.o. Man, 11 months post-renal transplantation. With papular and vesicular rash and abdominal pain.||+||NA||–||-DIC and gastrointestinal bleeding.||-Varicella vaccination should be administered before transplantation if patients had no past varicella infection based on history and antibody titre||Level 3|
|-36 y.o. Woman with a vesicular rash on face. Had renal transplant 3 years ago.||+||NA||–||-DIC|
|Fehr T, et al. (2002) ||-51 y.o. man, 11 years post-transplantation, had abdominal pain, nausea, vomiting, and generalised pustulosis.||+||NA||–||
-Pneumonitis and hypoxic respiratory failure.|
-Failure of graft 6 months later.
-Overall mortality of 34%. Mortality after 1990 with acyclovir and reduction of immunosuppressants were 22%.|
−82% of patients summarised had substantial mortality.
-Vaccination is effective and has no severe side effects.
-Routine VZV serology test for every ESRD patients before renal transplant.
-Vaccination in those with negative or very low VZV antibody titres.
|-34 y.o. Man, 1.5 years post-transplant, had acute epigastric pain, nausea, vomiting, and vesicular rash.||+||NA||–||-DIC, hepatitis.|
|-51 y.o. Man, 6 months post-transplant, admitted for progressive dyspnoea.||+||+||–||
-Pneumonitis with respiratory failure.|
-LOS: 26 days.
|-23 y.o. Man, 6 months post-transplant, presented with vesicles whole body.||+||+||–||
-LOS: 10 days
|Lauzurica R, et al. (2003) ||-30 y.o. Man presented with vesicular-pustular rash, fever and abdominal pain, 3.5 years post-transplant.||+||NA||+||
-Pneumonitis with respiratory failure|
-Died 4 days upon admission due to multiorgan failure: (hepatitis, myocarditis, DIC)
|-Detecting VZV seronegative patients before the renal transplant is relevant because vaccination may minimise the risks of future infection.||Level 3|
|Sinha S, et al. (2003) ||-22 y.o. Woman, 42 months post-transplant, presented with abdominal pain 1 week after the development of chickenpox.||+||NA||–||-Pancreatitis.||-Acute pancreatitis as a consequent of viral infection is well known||Level 3|
|-36 y.o. Man, 10 days post-transplant, developed pancreatitis 2 weeks after pancreatitis.||+||NA||–||-Mild acute pancreatitis|
|Robertson S, et al. (2005) ||-30 y.o. Man with a generalised maculopapular rash||+||NA||+||
-Fulminant varicella with multiorgan involvement (acute renal failure, acute liver failure)|
- Died within 60 h of admission
-Although regarded mild infection in children, chickenpox can cause fatality in adults and in the immunocompromised.|
-Screen potential renal transplant recipients for VZV susceptibility and offer vaccination to the seronegative patients.
-Test for immunity for varicella as soon as progressive renal failure is diagnosed.
|Rodríguez-Moreno A, et al. (2006) ||
-Eight patients (1%) developed varicella (7 men, 1 women).|
-Age range: 32–64.
-Median time from transplantation to infection was 32mths.
- 2 pneumonitis, 1 hepatitis, 1 thrombotic microangiopathy, 1 multiorgan failure
- LOS: 11 days (median 3 to 21).
- One (12.5%) death due to multiorgan failure
-Varicella infection in adult allograft recipients is unusual but highly morbid|
-Vaccination of seronegative pre-transplant candidates should be attempted
|Shahbazian H, et al. (2007) ||-37 y.o. Man, a year post-transplant, admitted for severe abdominal pain.||+||+||–||
-Acute kidney injury|
-LOS: 10 days
-All renal transplant recipients should be screened for VZV immunity before transplant irrespective of previous VZV infection.|
- Seronegative patients should receive live VZV vaccine several months prior to transplant.
|-44 y.o. Man, 9 years post-transplantation, admitted for low back pain of 2 days duration. 2 days later he developed fever and papulovesicular rash 2 days later||–||+||–||-LOS: 15 days|
|-34yo man, 8 years post-transplantation, admitted for acute abdominal pain with intractable nausea vomiting. Papulovesicular rash appeared on the face and trunk 48 h later before became generalised.||–||+||–||-LOS: 13 days|
|Crowther N, et al. (2008) ||-43 y.o. Man, 16 years post-renal transplant. Acute renal failure detected at routine clinic review. He had scattered skin lesion after his children had chickenpox 2 weeks ago.||+||NA||–||-Diagnosis: late acute mediated rejection post-transplant precipitated by recurrent varicella infection.||–||Level 3|
|Kandasamy R et al. (2009) ||-58 y.o. Man with fever and progressive rash||+||NA||–||-Darrier disease related to disseminated varicella||–||Level 3|
|Sato A, et al. (2009) ||-36 y.o. Woman presented with an irritable cough||+||+||–||
-LOS: 1 month and 10 days
|-One should keep the possibility of VZV reinfection in mind, in Immunocompromised patients with past history of varicella.||Level 3|
|Assi M, et al. (2011) ||-68 y.o. man with kidney transplant 10 years ago, presented with 5-days fever, confusion and altered sensorium||+||NA||–||Varicella encephalitis, followed by Guillain-Barre syndrome (GBS).||–||Level 3|
|Mustapic Z, et al. (2011) ||-Two renal allograft patients developed varicella. Details unavailable.||NA||NA||NA||-Not available||
-VZV infection is a rare but potentially serious complication in renal transplant recipients.|
-Active immunisation for VZV-seronegative patients before transplantation should be performed.
|Chiang E, et al. (2012) ||-42 y.o. Woman, unknown years post kidney transplant, had right eye redness, tearing, and blurred vision for 1 month.||+||NA||–||-Acute retinal necrosis||–||Level 3|
|Kaul A, et al. (2012) ||
-23 patients developed varicella in the 10-year review of post renal transplant.|
-Age range: 21–54 years old (median:39)
-17 male patients.
-Timing of infection: < 15 days post-transplant to > 5 years post-transplant.
-5 had graft dysfunction.|
- 7 had infections (6 bacterial, 1 fungal).
- 3 had sepsis
- 5 had gastritis
- 2 had encephalitis
- 2 had pancreatitis
- 2 had orchitis
- 2 died (8.6%)
-Primary varicella/chickenpox is a potentially fatal infection in adult renal transplant recipients.|
-Varicella vaccination in the high-risk groups, especially during the pre-ESRD stage, may reduce the number of varicella infection.
|Inokuchi R, et al. (2013) ||-A 69 y.o. Woman (20 years ESRD on dialysis, then 1 month post renal transplantation) presented with generalised rash one day.||+||NA||+||
-Varicella pneumonia with respiratory failure.|
-Demised at Day 28 illness (despite change of antiviral to foscarnet on day10, mechanical ventilation on day3)
|-Patients with VZV pneumonia with deep and vast ulcerations on bronchoscopy had fatal outcomes.||Level 3|
|Low LL, et al. (2014) ||-58 y.o. Man on haemodialysis, presented with fever and cough. Subsequently developed a papulovesicular rash on the 4th day of admission.||+||NA||–||
-Renal Physicians and Family Physicians in the Asia-Pacific region should study the epidemiological data in each country.|
-Consensus guidelines needed and how the varicella vaccination program can be targeted for those at risk.
-Live attenuated varicella vaccine is has been proven to be safe when administered to adult ESRD patients regardless of RRT mode.
|Nabi S, et al. (2014) ||-73 y.o. Woman with kidney transplantation and recent CMV infection, presented with altered mental status.||+||NA||–||-Varicella encephalitis||-Disseminated VZV with encephalitis is rare, but a life-threatening condition||Level 3|
|Sampathkumar K, et al. (2015) ||-34 y.o. Man had kidney transplant 10 months ago, came with fever × 2 weeks and bitemporal headache.||+||NA||–||-VZV induced central nervous system angiopathy||–||Level 3|
|Depledge D, et al. (2016) ||-55y.o. Man post renal transplant day23 presented with abdominal pain, macular rash and abnormal liver function test.||+||NA||–||-VZV pneumonitis, hepatitis||
-Risk of airborne transmission of VZV is evident, especially when viral load is high.|
- Immunocompromised patients are vulnerable to serious infection.
- Need for pre-transplant vaccination.
|-61y.o. Man post renal transplant day25 presented with 4 days fever, vesicular rash and abnormal liver function.||+||NA||+||
- Died on day 6 admission (3 days in ICU)
|Chhabra P, et al. (2017) ||-33y.o. Man, 3 years post-transplant, had severe epigastric pain for 7 days.||+||NA||–||-Varicella pancreatitis and hepatitis||–||Level 3|
|Momani H, et al. (2017) ||
-One patient developed varicella|
|+||NA||–||-Varicella pneumonitis||–||Level 3|