The following is a summary of “Clinical effectiveness of zoster vaccine live in kidney transplant recipients immunized prior to transplantation: a retrospective single-centre cohort study,” published in the July 2023 issue of the Clinical Microbiology and Infection by Kim et al.
Herpes zoster (HZ) and its complications are more common among recipients of kidney transplants (KT). Although recombinant zoster vaccine is preferred to zoster vaccine live (ZVL), ZVL is also recommended for preventing herpes zoster in KT candidates. Researchers’ objective was to assess the clinical efficacy of ZVL in KT recipients immunized before transplantation. Participants were adults who obtained a kidney transplant between January 2014 and December 2018.
Patients were monitored until HZ, mortality, allograft loss, loss of follow-up, or 5 years after transplantation, whichever came first. Using the inverse probability of the treatment-weighted Cox proportional hazard model, the incidence of HZ following transplantation was compared between vaccinated and unvaccinated patients. Included were a total of 84 vaccinated patients and 340 unvaccinated patients. In the vaccinated group, the median age was higher (57 versus 54 years, P= 0.003). In the unvaccinated group, more grafts from deceased donors were transplanted (16.7% vs. 51.8%, P<0.001). The cumulative incidence of HZ over five years was 11.9%, which translated to 26.27 (19.33–34.95; 95% CI) per 1,000 person-years.
The incidence was 3.9% in the vaccinated group and 13.7% in the unvaccinated group. After adjustment, vaccination was significantly protective against HZ (adjusted hazard ratio, 0.18; 95% confidence interval, 0.05–0.60). Additionally, all four cases of disseminated zoster occurred in the group that was not vaccinated. Their research, which is the first to examine the clinical efficacy of zoster vaccines for KT recipients, indicates that ZVL administered before transplantation effectively prevents HZ.